ISSN 1996-353Õ

ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË
Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί
ÌÅÄÈÖÈÍÈ
Îô³ö³éíèé æóðíàë
Óêðà¿íñüêîãî òîâàðèñòâà Ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè

UKRAINIAN JOURNAL OF
PHYSICAL AND REHABILITATION
MEDICINE

Official Journal of
Ukrainian Society of Physical and Rehabilitatoin Medicine

www.ujprm.com

ÄÎÄÀÒÎÊ
Ãîëîâíèé ðåäàêòîð:
Âëàäèìèðîâ Î.À. (Êè¿â)
×ëåíè ðåäêîëå㳿:
Àëèïîâà Î.Å. (Çàïîð³ææÿ), Aíê³í M.Ë. (Êè¿â),
Âàñèëüºâà-˳íåöüêà Ë.ß. (Õàðê³â),
Âëàäèìèðîâà Í.². (Êè¿â), Ãîëèê Â.À. (Äí³ïðî),
Ãóáåíêî Â.Ï. (Êè¿â), Äðàíîâñüêèé À.Ë. (Òðóñêàâåöü),
Êîë³ñíèê Ï.Ô. (³ííèöÿ), Ëåìêî ².Ñ. (Óæãîðîä),
Ìàðòèíþê Â.Þ. (Êè¿â), ̳íöåð Î.Ï. (Êè¿â),
̳ñóëà ².Ð. (Òåðíîï³ëü), Ïîëÿíñüêà Î.Ñ. (×åðí³âö³),
Ðîìàñêåâè÷ Þ.Î. (Õåðñîí), Ðîé ².Â. (Êè¿â),
Ñåìèêîïíà Ò.Â. (Êè¿â), Ñòåáëþê Â.Â. (Êè¿â),
Þøêîâñüêà Î.Ã. (Îäåñà).
Ðåäàêö³éíà ðàäà:
Àíòèïê³í Þ.Ã. (Êè¿â), Christodoulou Nicolas (ʳïð),
Frischknecht Rolf (Øâåéöàð³ÿ), Ãàéêî Ã.Â. (Êè¿â),
Grabljevec Klemen (Ñëîâåí³ÿ),
Gutenbrunner Christoph (ͳìå÷÷èíà),
Juocevicius Alvydas (Ëèòâà), Êîâàëåíêî Â.Ì. (Êè¿â),
Êîçÿâê³í Â.I. (Tðóñêàâåöü), Ëàçîð³øèíåöü Â.Â. (Êè¿â),
Ñåðäþê À.Ì. (Êè¿â), Ñóáîòà Ì.Â. (Êè¿â),
Òðîíüêî Ì.Ä. (Êè¿â), Öèìáàëþê Â.². (Êè¿â),
Óñåíêî Î.Þ. (Êè¿â), Âîðîíåíêî Þ.Â. (Êè¿â),
Xanthi Michail (Ãðåö³ÿ), ßêóáåíêî Ï.Ï. (Êè¿â),
Çàïîðîæàí Â.Ì. (Îäåñà), Zampolini Mauro (²òàë³ÿ)
Çàñíîâíèêè:
Íàö³îíàëüíà ìåäè÷íà àêàäåì³ÿ
ï³ñëÿäèïëîìíî¿ îñâ³òè ³ìåí³ Ï.Ë. Øóïèêà,
ÏÀÒ “Òðóñêàâåöüêóðîðò”,
ÃÎ “Óêðà¿íñüêå òîâàðèñòâî
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè”
Ïåð³îäè÷í³ñòü âèõîäó: 4 ðàçè íà ð³ê.
Ñâ³äîöòâî ïðî äåðæàâíó ðåºñòðàö³þ
äðóêîâàíîãî çàñîáó ìàñîâî¿ ³íôîðìàö³¿
Ñåð³ÿ ÊÂ ¹ 22530-12430Ð
Óñ³ ïðàâà ñòîñîâíî îïóáë³êîâàíèõ ñòàòåé çàëèøåíî
çà ðåäàêö³ºþ. ³äïîâ³äàëüí³ñòü çà äîá³ð òà âèêëàäåííÿ ôàêò³â
ó ñòàòòÿõ íåñóòü àâòîðè, à çà çì³ñò ðåêëàìíèõ ìàòåð³àë³â –
ðåêëàìîäàâö³. Ïåðåäðóê ìîæëèâèé çà çãîäè ðåäàêö³¿
òà ç ïîñèëàííÿì íà äæåðåëî.
Äî äðóêó ïðèéìàþòüñÿ íàóêîâ³ ìàòåð³àëè ÿê³ â³äïîâ³äàþòü
âèìîãàì äî ïóáë³êàö³¿ â äàíîìó âèäàíí³.
Ðåêîìåíäóºòüñÿ äî äðóêó òà äî ïîøèðåííÿ ÷åðåç ìåðåæó
²íòåðíåò ð³øåííÿì ó÷åíî¿ ðàäè ÍÌÀÏÎ ³ìåí³ Ï.Ë. Øóïèêà
â³ä 13.05.2018 ð., ïðîòîêîë ¹ 6
Àäðåñà äëÿ êîðåñïîíäåíö³¿:
Ðåäàêö³ÿ Óêðà¿íñüêîãî æóðíàëó ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè, avladimirov05@gmail.com
Âèäàâåöü: ÒΠ“Âèäàâíèöòâî “Ê²Ì“
Ñâ³äîöòâî ÄÊ ¹ 2888 â³ä 03.07.2007 ð.
ϳäïèñàíî äî äðóêó 04.12.2018 ð. Ôîðìàò 60õ84/8.
Òèðàæ 500. Çàì. ¹ 032-18.
2 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Chairman Of The Editorial Board:
Vladymyrov O.A. (Kiyv)
Editorial Board:
Alypova O.E. (Zaporizhia), Ankin M.L. (Kiyv),
Vasylieva-Linetska L.Ya. (Kharkiv),
Vladymyrova N.I. (Kiyv), Golyk V.A. (Dnipro),
Gubenko V.P. (Kiyv), Dranovskyi A.L. (Truskavets),
Kolisnyk P.F. (Vinnytsia), Lemko I.S. (Uzhhorod),
Martynyuk V.Yu. (Kiyv), Mintser O.P. (Kiyv),
Misula I.R. (Ternopil), Polyanska O.S. (Chernivtsi),
Romaskevych Yu.O. (Kherson), Roy I.V. (Kiyv),
Semykopna T.V. (Kiyv), Stebliuk V.V. (Kiyv),
Yushkovska O.G. (Odessa).
Editorial Council:
Antypkin Yu.G. (Kiyv), Christodoulou Nicolas (Cyprus),
Frischknecht Rolf (Switzerland), Gaiko G.V. (Kiyv),
Grabljevec Klemen (Slovenia),
Gutenbrunner Christoph (Germany),
Juocevicius Alvydas (Lithuania), Kovalenko V.M. (Kiyv),
Kozyavkin V.I. (Truskavets), Lazorishynets V.V. (Kiyv),
Serdyuk A.M. (Kiyv), Subota M.V. (Kiyv),
Tronko M.D. (Kiyv), Tsymbalyuk V.I. (Kiyv),
Usenko O.Yu. (Kiyv), Voronenko Yu.V. (Kiyv),
Xanthi Michail (Greece), Yakubenko P.P. (Kiyv),
Zaporozhan V.M. (Odessa), Zampolini Mauro (Italy).
Founders:
Shupyk National Medical Academy
of Postgraduate Education,
PJSC “Truskavetskurort”,
PO “Ukrainian Society for Physical
and Rehabilitation Medicine”
Publication frequency: 4 times a year.
Registration Certificate
ÊÂ ¹ 22530-12430 Ð
All rights concerning published articles are reserved to the
editorial board. Responsibility for selection and presentation
of the facts in the articles is held by authors, and of the content
of advertising material – by advertisers. Reprint is possible with
consent of the editorial board and reference.
Research materials accepted for publishing must meet
the publication requirements of this edition.
Correspondence address:
Editorial board of the Ukrainian Physical and Rehabilitation
Medicine, avladimirov05@gmail.com
Publisher: “ʲ̔ Publishing house” Ltd.
Certificate ÄÊ ¹ 2888 from 03.07.2007
Signed in print on 04.12.2018. Format 60õ84/8 Offset print.
Offset paper. Circulation: 500. Order ¹ 032-18.
¹2(2) *2018
 Øàíîâí³ äðóç³, êîëåãè-îäíîäóìö³!
Ìàºìî çà ÷åñòü ïðåäñòàâèòè Âàì óêðà¿íñüêèé
ïåðåêëàä 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà
Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³. Äëÿ íàøèõ
ºâðîïåéñüêèõ êîëåã öå º ãîëîâíèì äæåðåëîì, ùî
ì³ñòèòü ñèñòåìàòèçîâàíèé îïèñ óñ³õ àñïåêò³â ïåð-
âèííî¿ ë³êàðñüêî¿ ñïåö³àëüíîñò³ «ô³çè÷íà òà ðåàá³-
ë³òàö³éíà ìåäèöèíà». Á³ëà Êíèãà º êëþ÷îâèì ºâðî-
ïåéñüêèì äîâ³äíèêîì äëÿ ë³êàð³â, ñòóäåíò³â,
îñâ³òÿí, îðãàí³çàòîð³â îõîðîíè çäîðîâ’ÿ, çàëó÷åíèõ
äî íàäàííÿ ðåàá³ë³òàö³éíî¿ äîïîìîãè òà ï³äãîòîâ-
êè ôàõ³âö³â ç ðåàá³ë³òàö³¿. Ç ö³ºþ Êíèãîþ ºâðî-
ïåéñüê³ îðãàí³çàö³¿ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìå-
äèöèíè çâåðòàþòüñÿ ç óñ³ìà ïèòàííÿìè, ùî
ñòîñóþòüñÿ áàãàòüîõ àñïåêò³â ðåàá³ë³òàö³¿, äî
ì³í³ñòåðñòâ, óðÿä³â, ïàðëàìåíò³â ñâî¿õ êðà¿í òà
êåð³âíèõ îðãàí³â ªâðîïåéñüêîãî Ñîþçó.
Óêðà¿íà çíàõîäèòüñÿ íà ñàìîìó ïî÷àòêó ñèñ-
òåìíîãî òà ïîñë³äîâíîãî ðóõó â íàïðÿìêó ñó÷àñíî¿
ìóëüòè-ïðîôåñ³éíî¿, ïàö³ºíò-öåíòðè÷íî¿ òà ö³ëü-
ñïðÿìîâàíî¿ ðåàá³ë³òàö³¿. Ìè ìàºìî ùå îïàíóâàòè
ñó÷àñíó ðåàá³ë³òàö³éíó òåðì³íîëîã³þ, ÿêà ïîêè º
â³äñóòíüîþ â óêðà¿íñüê³é ìîâ³, óñâ³äîìèòè òà ïðèé-
íÿòè áàçîâ³ ïðèíöèïè îðãàí³çàö³¿ ðåàá³ë³òàö³éíî¿
äîïîìîãè, íàëàøòóâàòè ñâ³äîìó òà ïðîäóêòèâíó
êîìàíäíó ñï³âïðàöþ ì³æ ³ñíóþ÷èìè ïðàáàòüêàìè
ìàéáóòí³õ ôàõ³âö³â ç ðåàá³ë³òàö³¿ òà ïðîíåñòè
â³ôëåºìñüêèé âîãîíü ðåàá³ë³òàö³éíî¿ ³äå¿ ÷åðåç
àãðåñèâíå òà ðèã³äíå ïàâóòèííÿ íàøèõ ÷èííèõ íîð-
ìàòèâíî-ïðàâîâèõ òà ðåãóëÿòîðíèõ äîêóìåíò³â,
îäíî÷àñíî äîêîð³ííî çì³íþþ÷è ¿õ.
Á³ëà Êíèãà º ñèñòåìíèì äæåðåëîì ïåðâèííî¿
ðåàá³ë³òàö³éíî¿ ³íôîðìàö³¿, ÿêà ÷³òêî îïèñóº øëÿõ
ðîçâèòêó ñïåö³àëüíîñò³ «ô³çè÷íà òà ðåàá³ë³òàö³éíà
ìåäèöèíà» â êîíòåêñò³ ºâðîïåéñüêî¿ ðåàá³ë³òàö³¿,
äåìîíñòðóº ñó÷àñí³ âèìîãè, ïð³îðèòåòè òà ïåðñïåê-
òèâè, à òàêîæ ìàéáóòí³ âèêëèêè.
Òîæ ºäíàºìî íàø³ çóñèëëÿ òà âèðóøàéìî ðàçîì
äî íàøî¿ ñï³ëüíî¿ óêðà¿íñüêî¿ ðåàá³ë³òàö³éíî¿ ìåòè!
Ðåäàêòîðè óêðà¿íñüêîãî ïåðåêëàäó:
Âîëîäèìèð Ãîëèê
Îëåêñàíäð Âëàäèìèðîâ
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Dear friends, like-minded colleagues!
We have the honour to present you the Ukrainian
translation of 3rd edition of the White Book on Physical
and Rehabilitation Medicine in Europe. For our
European colleagues, this is the main source containing
systematic description of all aspects of the primary
medical specialty “Physical and Rehabilitation
Medicine”. The White Book is a key European
reference for physicians, students, educators, health
care planners, involved in providing rehabilitation
service and train rehabilitation professionals. With this
Book, European Physical and Rehabilitation Medicine
organizations address all issues regarding many
aspects of rehabilitation, to ministries, governments,
parliaments of their countries and governing bodies of
the European Union.
Ukraine is at the very beginning of systematic and
consistent way towards modern multi-professional,
patient-centred and goal-oriented rehabilitation. We
still need to master modern rehabilitation terminology
that is not yet present in Ukrainian language, to
understand and adopt basic principles of rehabilitation
service organization, to set up a conscious and
productive team collaboration between the existing
progenitors of future rehabilitation professionals and
to carry the Bethlehem fire of the rehabilitation idea
through aggressive and rigorous spiderweb of our
current legislative and regulatory documents,
simultaneously changing them fundamentally.
The White Book is the systematic source of
primary rehabilitation information, clearly describes the
pathway of “Physical and Rehabilitation Medicine”
specialty in the context of European rehabilitation,
demonstrates modern requirements, priorities and
perspectives, as well as future challenges.
So uniting our efforts and moving together toward
our common Ukrainian rehabilitation goal!
Editors of Ukrainian translation
Volodymyr Golyk
Oleksandr Vladymyrov
3
 Ïîäÿêè
Âèñëîâëþºìî ïîäÿêó çà ô³íàíñîâó ï³äòðèì-
êó ïåðåêëàäó Á³ëî¿ Êíèãè ÷ëåíàì Óêðà¿íñüêî-
ãî òîâàðèñòâà ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìå-
äèöèíè, ÏðÀÒ «Óêðïðîôîçäîðîâíèöÿ» òà
Ïîñîëüñòâó ×åñüêî¿ Ðåñïóáë³êè â Óêðà¿í³.
Ìè ö³íóºìî íàøó ñï³âïðàöþ ç êîîðäèíàö³¿
ðåàá³ë³òàö³éíî¿ òåðì³íîëî㳿 óêðà¿íñüêîþ ìîâîþ
ç Îëüãîþ Ìàíãóøåâîþ, Îêñàíîþ Ëÿëüêîþ òà
Êîñòÿíòèíîì Êàë³íê³íèì.
Ìè áóëè ðàä³ ïë³äí³é ñï³âïðàö³ ç ãðóïîþ
ïåðåêëàäó – Êèðèëë Âåðè÷ òà Â’ÿ÷åñëàâ
Øàðãîðîäñüêèé.
4 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Acknowledgements
We express our gratitude for financial support of
White Book translation process to members of
Ukrainian Society of Physical and Rehabilitation
Medicine, JSC “Ukrprofozdorovnytsya” and the
Embassy of the Czech Republic in Ukraine.
We appreciate our cooperation with Olga
Mangusheva, Oksana Lyalka and Konstyantin
Kalinkin in co-ordinating rehabilitation terminology
in Ukrainian.
We were happy to cooperate with group for
translation: Kirill Verich and Viacheslav
Shargorodskyi.
¹2(2) *2018
 Á²ËÀ ÊÍÈÃÀ
ç
Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè
(ÔÐM) â ªâðîï³

Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â

Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ªâðîïåéñüêà Àêàäåì³ÿ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ)

ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ªÒÔÐÌ)
Ñåêö³ÿ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â
(Ñåêö³ÿ ªÑÌÑ-ÔÐÌ)
ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ)

Îðèã³íàëüíà âåðñ³ÿ îïóáë³êîâàíà ó

Eur. J. Phys. Rehabil. Med. 2018 Apr; 54(2):125-321

 Á²ËÀ ÊÍÈÃÀ
ç
Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³

Ç̲ÑÒ
7 ÎÐÃÀͲÇÀÖ²¯ Ô²ÇÈ×ί ÒÀ
Ïåðåäìîâà ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ
8  ªÂÐÎϲ
Ïðîëîã 70
10 Ðîçä³ë 4. ²ñòîð³ÿ ñïåö³àëüíîñò³: çâ³äêè
Êîðîòêèé çì³ñò ïîõîäèòü Ô³çè÷íà òà Ðåàá³ë³òàö³éíà
Ìåäèöèíà
13
Ââåäåííÿ 82
Ðîçä³ë 5.Îðãàí³çàö³¿ Ô³çè÷íî¿ òà
14 Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³:
Ìåòîäîëîã³ÿ òðåòüîãî âèäàííÿ Á³ëî¿ Êíèãè ç ñòðóêòóðà òà ä³ÿëüí³ñòü
Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè ó
ªâðîï³ ÏÐÀÊÒÈÊÀ Ô²ÇÈ×ί ÒÀ ÐÅÀÁ²ËÒÖ²ÉÍί
19 ÌÅÄÈÖÈÍÈ Â ªÂÐÎϲ
Ãëîñàð³é 97
25 Ðîçä³ë 6. Çíàííÿ òà íàâè÷êè ë³êàð³â Ô³çè÷íî¿
Ñïèñîê ó÷àñíèê³â òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

37 113
Ñêîðî÷åííÿ Ðîçä³ë 7. Ñôåðà êë³í³÷íèõ êîìïåòåíòíîñòåé:
Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà íà
ÏÅÐÅÄÓÌÎÂÈ Ô²ÇÈ×Íί ÒÀ ïðàêòèö³
ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ 145
39 Ðîçä³ë 8. Ñïåö³àëüí³ñòü Ô³çè÷íà òà
Ðîçä³ë 1. Âèçíà÷åííÿ òà ïîíÿòòÿ Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíà Ìåäèöèíà â ñèñòåì³ îõîðîíè
Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè çäîðîâ’ÿ òà ñóñï³ëüñòâ³
49 164
Ðîçä³ë 2. ×îìó ðåàá³ë³òàö³ÿ ïîòð³áíà Ðîçä³ë 9. Îñâ³òà ³ áåçïåðåðâíèé ïðîôåñ³éíèé
³íäèâ³äóóìó òà ñóñï³ëüñòâó? ðîçâèòîê: ôîðìóâàííÿ ìàéáóòíüîãî Ô³çè÷íî¿
òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè
61
Ðîçä³ë 3. Ïåðâèííà ìåäè÷íà ñïåö³àëüí³ñòü: 172
îñíîâè Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ðîçä³ë 10. Íàóêà òà äîñë³äæåííÿ ó Ô³çè÷í³é
Ìåäèöèíè òà Ðåàá³ë³òàö³éí³é Ìåäèöèí³: îñîáëèâîñò³ òà
ïðîáëåìè

ØËßÕ ÂÏÅÐÅÄ
196
Ðîçä³ë 11. Âèêëèêè òà ïåðñïåêòèâè
ìàéáóòíüîãî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè

6 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐM) â ªâðîï³
Âñòóï, êîðîòêèé çì³ñò òà ìåòîäîëîã³ÿ
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
Á³ëà êíèãà (ÁÊ) ç ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà ªâðîïåéñüêèìè Îðãàíàìè
ÔÐÌ ³ º äîâ³äíèêîì äëÿ ë³êàð³â ÔÐÌ ó ªâðîï³.  äàíèé ÷àñ âîíà äîñÿãëà ñâîãî òðåòüîãî âèäàííÿ; ïåðøå áóëî
îïóáë³êîâàíî ó 1989 ðîö³, à äðóãèé – â 2006/2007 ðîö³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî âêëþ÷àþòü çàáåçïå÷åííÿ êîíñî-
ë³äóþ÷î¿ ñèñòåìè äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³îíàëü-
íîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòåð³àë³â äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìóâàííÿ ïðî ÔÐÌ ìåäè÷íî¿
ñï³ëüíîòè, ³íøèõ ôàõ³âö³â ðåàá³ë³òàö³¿ òà ãðîìàäñüêîñò³.
ÁÊ íàãîëîøóº íà âàæëèâîñò³ ÔÐÌ – ïåðâèííî¿ ìåäè÷íî¿ ñïåö³àëüíîñò³, ÿêà ïðåäñòàâëåíà â óñ³é ªâðîï³, ç îñîáëèâèì
corpus disciplinae, çàãàëüíèìè ïåðåäóìîâàìè òà ³ñòîð³ºþ ïî âñ³º¿ ªâðîï³. ÔÐÌ º ì³æíàðîäíî âèçíàíîþ òà º ïàðòíåðîì
ïðîâ³äíèõ ì³æíàðîäíèõ îðãàí³â, âêëþ÷àþ÷è Âñåñâ³òíþ îðãàí³çàö³þ îõîðîíè çäîðîâ’ÿ (ÂÎÎÇ). ijÿëüí³ñòü ÔÐÌ áà-
çóºòüñÿ ñòðîãî íà äîêóìåíòàõ Îðãàí³çàö³¿ Îá’ºäíàíèõ Íàö³é (ÎÎÍ) òà ÂÎÎÇ, òàêèõ ÿê Êîíâåíö³ÿ ïðî ïðàâà îñ³á ç
îáìåæåííÿìè æèòòºä³ÿëüíîñò³ (2006), Âñåñâ³òíÿ äîïîâ³äü ç îáìåæåíü æèòòºä³ÿëüíîñò³ (2011), Ãëîáàëüíèé Ïëàí ä³é
ÂÎÎÇ ç îáìåæåíü æèòòºä³ÿëüíîñò³ íà 2014-2021 ðîêè (2014) òà ³í³ö³àòèâà ÂÎÎÇ “Ðåàá³ë³òàö³ÿ 2030: çàêëèê äî ä³é”
(2017).
ÁÊ ñêëàäàºòüñÿ ç ÷îòèðüîõ ÷àñòèí, 11 ðîçä³ë³â òà äåê³ëüêîõ äîäàòê³â. ÁÊ ïî÷èíàºòüñÿ ç áàçîâèõ âèçíà÷åíü òà êîíöåïö³é
ÔÐÌ òà ïðîäîâæóºòüñÿ, ÷îìó ðåàá³ë³òàö³ÿ º íåîáõ³äíîþ äëÿ îñ³á òà ñóñï³ëüñòâà. Ðåàá³ë³òàö³ÿ çîñåðåäæóºòüñÿ íå ò³ëüêè
íà ñòàíàõ çäîðîâ’ÿ, àëå é íà ôóíêö³îíóâàíí³. ³äïîâ³äíî, ÔÐÌ º ìåäè÷íîþ ñïåö³àëüí³ñòþ, ÿêà ïðàãíå ïîë³ïøèòè
ôóíêö³îíóâàííÿ ëþäåé ç ñòàíàìè çäîðîâ’ÿ àáî òèìè, ùî çàçíàþòü îáìåæåíü æèòòºä³ÿëüíîñò³. Ïðåäñòàâëåí³ îñíîâè
ÔÐÌ, ³ñòîð³ÿ ñïåö³àëüíîñò³ ÔÐÌ òà ñòðóêòóðà é ä³ÿëüí³ñòü îðãàí³çàö³é ÔÐÌ â ªâðîï³, ï³ñëÿ ÷îãî ðåòåëüíî ïðåäñòàâ-
ëåíà ïðàêòèêà ÔÐÌ, íàïðèêëàä çíàííÿ òà íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà êë³í³÷íèõ êîìïåòåíòíîñòåé ÔÐÌ, ì³ñöå ñïåö³-
àëüíîñò³ ÔÐÌ ó ñèñòåì³ îõîðîíè çäîðîâ’ÿ òà ñóñï³ëüñòâ³, îñâ³òà òà áåçïåðåðâíèé ïðîôåñ³éíèé ðîçâèòîê ë³êàð³â ÔÐÌ,
îñîáëèâîñò³ òà ïðîáëåìè íàóêè òà äîñë³äæåíü ó ÔÐÌ. ÁÊ çàê³í÷óºòüñÿ âèçíà÷åííÿì ïîäàëüøîãî øëÿõó äëÿ ñïåö³àëü-
íîñò³: âèêëèêàìè òà ïåðñïåêòèâàìè äëÿ ìàéáóòíüîãî ÔÐÌ.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine in Europe. Introductions, Executive Summary, and Methodology. Eur J Phys Rehabil
Med 2018;54:125-55.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Âñòóï, êîðîòêèé çì³ñò òà ìåòîäîëîã³ÿ Óêðà¿íñüêèé
æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 7–38
Êëþ÷îâ³ ñëîâà: ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà – ªâðîïà – ôóíêö³îíóâàííÿ – îáìåæåííÿ æèòòºä³ÿëüíîñò³.

введення тексту

Ïåðåäìîâà Äðóãå âèäàííÿ ÁÊ ç ÔÐÌ â ªâðîï³ ìàëî çà ìåòó

Ïåðøå âèäàííÿ Á³ëî¿ Êíèãè ç ÔÐÌ â ªâðîï³
áóëî íàïèñàíî ç àìá³ö³ÿìè ñòàòè ðîáî÷èì ³íñòðó-
ìåíòîì, ÿêèé äîçâîëèòü îðãàíàì îõîðîíè çäîðî-
â’ÿ òà ìåäè÷íèì âèêëàäà÷àì çä³éñíèòè íåîáõ³ä-
íèõ ðåãóëÿòîðíèõ êðîê³â äî îáîâ’ÿçêîâîãî
âêëþ÷åííÿ ÔÐÌ â ìåäè÷íå íàâ÷àííÿ, à òàêîæ
äîñÿãòè åôåêòèâíî¿, îïòèì³çîâàíî¿ ãàðìîí³çàö³¿
íàâ÷àííÿ ôàõ³âö³â ç ÔÐÌ â ªâðîï³.
çàáåçïå÷åííÿ, ùîá ÔÐÌ ðîçãëÿäàëàñü, ÿê âèçíà-
íà ºâðîïåéñüêà ìåäè÷íà ñïåö³àëüí³ñòü, äå âèñîêî-
êâàë³ô³êîâàí³ ïðàêòèêóþ÷è ôàõ³âö³ çàáåçïå÷óþòü
ãàðí³ ñòàíäàðòè äîïîìîãè, ïðàêòèêà ´ðóíòóºòüñÿ íà
íàóêîâèõ äîêàçàõ òà â óìîâàõ â³äïîâ³äíèõ íàö³î-
íàëüíèõ êîíòåêñò³â. Öå äîñÿãíóòî âèçíà÷åííÿì
ñïåö³àëüíîñò³ ÔÐÌ, ¿¿ ðîáîòè, êîìïåòåíòíîñòåé ¿¿
ïðàêòèêóþ÷èõ ôàõ³âö³â òà ¿¿ çâ’ÿçê³â ç ³íøèìè ìå-
äè÷íèìè äèñöèïë³íàìè òà ñóì³æíèìè ïðîôåñ³ÿìè
â ñôåð³ îõîðîíè çäîðîâ’ÿ.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 7
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Îáèäâà âèäàííÿ Á³ëî¿ êíèãè ç ÔÐÌ â ªâðîï³
áóëè äîáðå ñïðèéíÿò³ íå ò³ëüêè ïðîôåñ³îíàëàìè ó
ñôåð³ îõîðîíè çäîðîâ’ÿ, àëå é ïîë³òèêàìè, ÿê³ øè-
ðîêî âèêîðèñòîâóâàëè ³íôîðìàö³þ, ùî ì³ñòèòüñÿ
â Á³ë³é êíèç³, äëÿ îðãàí³çàö³¿ íàäàííÿ ðåàá³ë³òàö³é-
íî¿ äîïîìîãè. Çà äåñÿòü ðîê³â ï³ñëÿ âèõîäó äðóãî-
ãî âèäàííÿ ªâðîïåéñüê³ Îðãàíè ÔÐÌ ââàæàþòü çà
ñâîº÷àñíå îíîâëåííÿ çì³ñòó Á³ëî¿ êíèãè, äëÿ òîãî,
ùîá ïðîäåìîíñòðóâàòè, ÿêîãî ðîçâèòêó çäîáóëà öÿ
ñïåö³àëüí³ñòü, òà ÿê îñòàíí³ òåíäåíö³¿ âïëèâàþòü
íà ïðàêòèêó.
Òðåòå âèäàííÿ Á³ëî¿ êíèãè ÔÐÌ â ªâðîï³ ðîç-
ðîáëåíî Àëüÿíñîì ªâðîïåéñüêèõ Îðãàí³â ÔÐÌ
(Ñåêö³ÿ ÔÐÌ ªÑÌÑ, ªâðîïåéñüêèé êîëåäæ ÔÐÌ
(â îñîá³ Ðàäè ÔÐÌ ªÑÌÑ), ªÒÔÐÌ òà ªÀÐÌ).
 ðåçóëüòàò³ ñï³ëüíèõ çóñèëü ïðåäñòàâíèê³â öèõ
îðãàí³â ÔÐÌ, ÿê³ º â³äïîâ³äàëüíèìè çà âñòàíîâëåí-
íÿ ñòàíäàðò³â êë³í³÷íî¿ ïðàêòèêè ÔÐÌ, îñâ³òè òà
íàóêîâèõ äîñë³äæåíü â ªâðîï³, Á³ëà êíèãà â³äîáðà-
æຠð³çí³ àñïåêòè, íåîáõ³äí³ äëÿ ðîçðîáêè â³äïîâ³-
äíî¿, øèðîêî äîñòóïíî¿ òà ïîñò³éíî¿ ðåàá³ë³òàö³é-
íî¿ äîïîìîãè. Âîíà º äîâ³äíèêîì äëÿ ë³êàð³â ÔÐÌ
â ªâðîï³, êåðóº ¿õ âçàºìî䳺þ ç îñîáàìè ç îáìå-
æåííÿìè æèòòºä³ÿëüíîñò³, ç êîëåãàìè ç ³íøèõ ìå-
äè÷íèõ äèñöèïë³í òà ñóì³æíèìè ïðîôåñ³îíàëàìè â
ñôåðè îõîðîíè çäîðîâ’ÿ, à òàêîæ ó ïåðåãîâîðàõ ç
â³äïîâ³äíèìè íàö³îíàëüíèìè óðÿäàìè òà íàö³î-
íàëüíèìè îðãàíàìè îõîðîíè çäîðîâ’ÿ.
Òðåòº âèäàííÿ Á³ëî¿ êíèãè ÔÐÌ â ªâðîï³ ìຠçà
ìåòó:
– îïèñ ðîáîòè ñïåö³àëüíîñò³ ÔÐÌ òà ë³êàð³â ÔÐÌ
â ì³íëèâîìó ñâ³ò³ ñèñòåì îõîðîíè çäîðîâ’ÿ òà
ñêîðî÷åííÿ ðåñóðñ³â;
– ðåàãóâàííÿ òà âíåñîê äî ìåäè÷íèõ ³ííîâàö³é;
– ðîçðîáêó ñòðàòåã³é âèð³øåííÿ çàâäàíü íàóêîâî-
òåõí³÷íîãî ïðîãðåñó;
– ðîáîòó ç ì³íëèâèìè ïåðñïåêòèâàìè îáìåæåíü
æèòòºä³ÿëüíîñò³;
– ñïðèÿííÿ òà ïîëåãøåííÿ ñàìîñò³éíîñò³ ëþäåé
ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà ¿õ ó÷àñò³ â
ïîâñÿêäåííîìó æèòò³;
– âñòàíîâëåííÿ ñåáå, ÿê äîâ³äíèêà äëÿ ïðàêòèêè
ÔÐÌ òà àêàäåì³÷íîãî æèòòÿ ìîëîäèõ ïðîôå-
ñ³îíàë³â îõîðîíè çäîðîâ’ÿ (îñîáëèâî ë³êàð³â ïðî-
òÿãîì íàâ÷àííÿ);
– ï³äêðåñëåííÿ ºâðîïåéñüêî¿ ïåðñïåêòèâè.
Á³ëà êíèãà ñêëàäàºòüñÿ ç ÷îòèðüîõ ÷àñòèí, 11
ðîçä³ë³â òà äåê³ëüêîõ äîäàòê³â. Öå “êîëåêòèâí³ çó-
ñèëëÿ” âñ³õ äåëåãàò³â òà ÷ëåí³â ªâðîïåéñüêèõ
Îðãàí³â. ¯¿ ïðîäóìàíà ³ ïðàêòè÷íà ñòðóêòóðà, ÿêà
ðåòåëüíî âèòðèìàíà ðåäàêòîðàìè ï³ä êîîðäèíàö³ºþ
ïðîôåñîðà Stefano Negrini, ñïðèÿòèìå âïëèâó Á³ëî¿
êíèãè òà óñï³øíîìó âïðîâàäæåííþ â ïðàêòèêó
ÔÐÌ ó ªâðîï³.
8 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ìè õî÷åìî ñêîðèñòàòèñü ö³ºþ ìîæëèâ³ñòþ,
ùîá ïðèâ³òàòè âñ³õ àâòîð³â, ÿê³ çðîáèëè âíåñîê ó
çì³ñò ö³º¿ âàæëèâî¿ ïóáë³êàö³¿.
Â³ä ³ì’ÿ Àëüÿíñó ªâðîïåéñüêèõ Îðãàí³â ÔÐÌ
Ïðåçèäåíòè ªâðîïåéñüêèõ Îðãàí³â ÔÐÌ
Xanthi Michail (ªâðîïåéñüêà àêàäåì³ÿ
ðåàá³ë³òàö³éíî¿ ìåäèöèíè)
Alain Delarque (ªâðîïåéñüêå òîâàðèñòâî ô³çè÷íî¿ òà
ðåàá³ë³òàö³éíî¿ ìåäèöèíè)
Nicolas Christodoulou (Ñåêö³ÿ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè ªâðîïåéñüêîãî Ñîþçó ìåäè÷íèõ ñïåö³àë³ñò³â)
Maria Gabriella Ceravolo (ªâðîïåéñüêèé êîëåäæ
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè).
Ïðîëîã
Á³ëà êíèãà (ÁÊ) ç ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ñëóãóâàëà äîâ³äíèêîì
äëÿ ë³êàð³â ÔÐÌ â ªâðîï³ ç 1989 ðîêó, êîëè
Universidad Complutense of Madrid1 çà ³í³ö³àòèâîþ
ªâðîïåéñüêî¿ àêàäå쳿 ðåàá³ë³òàö³éíî¿ ìåäèöèíè
(ªÀÐÌ), Ñåêö³¿ ô³çè÷íî¿ ìåäèöèíè òà ðåàá³ë³òàö³¿
ªâðîïåéñüêîãî Ñîþçó ìåäè÷íèõ ñïåö³àë³ñò³â
(ªÑÌÑ) òà ªâðîïåéñüêî¿ ôåäåðàö³¿ ô³çè÷íî¿ ìåäè-
öèíè òà ðåàá³ë³òàö³¿ (ªÔÔÌÐ) áóëî îïóáë³êîâàíî
¿¿ ïåðøå âèäàííÿ. Öå ïåðøå âèäàííÿ òåïåð ìàº
³ñòîðè÷íó ö³íí³ñòü íå ò³ëüêè òîìó, ùî ñâ³ò ç òîãî
÷àñó çíà÷íî çì³íèâñÿ, àëå ³ ÔÐÌ òàêîæ ðîçâèíó-
ëàñü. Îñîáëèâî çì³íèëîñÿ êîëî ïîâíîâàæåíü ñïå-
ö³àëüíîñò³, ùî â³äîáðàæຠêîíöåïòóàëüíó åâîëþ-
ö³þ çäîðîâ’ÿ â³äïîâ³äíî äî êëàñèô³êàö³é
Âñåñâ³òíüî¿ îðãàí³çàö³¿ îõîðîíè çäîðîâ’ÿ (ÂÎÎÇ) –
ñïî÷àòêó â 1980 ðîö³ – ̳æíàðîäíî¿ êëàñèô³êàö³¿
ïîðóøåíü, îáìåæåíü æèòòºä³ÿëüíîñò³ òà ñîö³àëü-
íî¿ íåäîñòàòíîñò³ (ÌÊÏ) 2, à ïîò³ì ó 2001ð. äî
̳æíàðîäíî¿ êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ, îáìå-
æåíü æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ) 3. Öÿ
åâîëþö³ÿ çàñâ³ä÷óºòüñÿ ³ì’ÿì ñïåö³àëüíîñò³, ÿêà
çàðàç íàçèâàºòüñÿ ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäè-
öèíà. ³äïîâ³äíî, çàä³ÿí³ ªâðîïåéñüê³ Îðãàíè òà-
êîæ çì³íèëèñÿ: òåïåð âîíè ñêëàäàþòüñÿ ç ªâðîïåé-
ñüêî¿ àêàäå쳿 ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ªÀÐÌ –
åòè÷íà òà “ô³ëîñîôñüêà” ôóíêö³¿), ªâðîïåéñüêîãî
òîâàðèñòâà ÔÐÌ (ªÒÔÐÌ – íàóêîâà ôóíêö³ÿ),
Ñåêö³¿ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó ìåäè÷íèõ
ñïåö³àë³ñò³â (ïðîôåñ³éíà ôóíêö³ÿ) òà ªâðîïåéñüêîãî
êîëåäæó ÔÐÌ (â îñîá³ Ðàäè ÔÐÌ ªÑÌÑ –
íàâ÷àëüíà ôóíêö³ÿ).
Ó 2006 ðîö³ âîíè âèïóñòèëè äðóãå âèäàííÿ, ÿêå
â òîé ÷àñ áóëî îïóáë³êîâàíî Europa Medicophysica
(íèí³ European Journal of PRM) 4 òà Journal of
Rehabilitation Medicine5. Ó öüîìó òðåòüîìó âèäàíí³
ªâðîïåéñüê³ Îðãàíè ÔÐÌ ç³áðàëèñÿ ðàçîì ï³ä íà-
çâîþ “Àëüÿíñ ªâðîïåéñüêèõ Îðãàí³â ÔÐÌ”, ùîá
çàÿâèòè ïðî ñï³âïðàöþ, ÿêà ³ñíóâàëà ³ çðîñòàëà
¹2(2) *2018

ïðîòÿãîì áàãàòüîõ ðîê³â. Àëüÿíñ âîëî䳺 ³íòåëåê-
òóàëüíîþ âëàñí³ñòþ òà àâòîðñüêèìè ïðàâàìè íà
Á³ëó Êíèãó, à òàêîæ íà ¿¿ âèäàííÿ ð³çíèìè ìîâàìè.
ϳñëÿ äðóãîãî âèäàííÿ ÁÊ, Êîíâåíö³ÿ Îðãàí³-
çàö³¿ Îá’ºäíàíèõ Íàö³é (ÎÎÍ) ïðî ïðàâà ëþäåé ç
îáìåæåííÿìè æèòòºä³ÿëüíîñò³ (íàäàë³ “Êîíâåí-
ö³ÿ”)6 ³ìïëåìåíòóâàëà âàæëèâó ñòàòòþ 26 “Àá³-
ë³òàö³ÿ òà ðåàá³ë³òàö³ÿ”7. Âïåðøå ðåàá³ë³òàö³ÿ âèç-
íà÷àºòüñÿ, ÿê îäíå ç íàéâàæëèâ³øèõ âòðó÷àíü,
ñïðÿìîâàíèõ íà “óìîæëèâëåííÿ îñ³á ç îáìåæåí-
íÿìè æèòòºä³ÿëüíîñò³ äîñÿãíóòè é çáåðåãòè ìàê-
ñèìàëüíó íåçàëåæí³ñòü, ïîâíèõ ô³çè÷íèõ, ðîçóìî-
âèõ, ñîö³àëüíèõ òà ïðîôåñ³éíèõ çä³áíîñòåé ³ ïîâíîãî
âêëþ÷åííÿ é çàëó÷åííÿ äî âñ³õ àñïåêò³â æèòòÿ”.
³äïîâ³äíî, Êîíâåíö³ÿ çàêëèêàëà ñóâåðåíí³ äåðæà-
âè «îðãàí³çîâóâàòè, çì³öíþâàòè òà ðîçøèðþâàòè
êîìïëåêñí³ àá³ë³òàö³éí³ òà ðåàá³ë³òàö³éí³ ïîñëóãè é
ïðîãðàìè, îñîáëèâî ó ñôåð³ îõîðîíè çäîðîâ’ÿ, çàé-
íÿòîñò³, îñâ³òè é ñîö³àëüíîãî îáñëóãîâóâàííÿ». Öÿ
ñòàòòÿ òàêîæ âêëþ÷àëà “ðîçâèòîê ïåðâèííîãî òà
áåçïåðåðâíîãî íàâ÷àííÿ ñïåö³àë³ñò³â ³ ïåðñîíàëó,
ÿê³ ïðàöþþòü ó ñôåð³ àá³ë³òàö³éíèõ ³ ðåàá³ë³òàö³é-
íèõ ïîñëóã”. Äëÿ ÔÐÌ òóò º äâà âàæëèâèõ ïî-
â³äîìëåííÿ, à ñàìå: 1) äîñòóï äî ðåàá³ë³òàö³¿ – öå
ïðàâî ëþäèíè òà 2) ï³äãîòîâêà âèñîêîêâàë³ô³êîâà-
íèõ ôàõ³âö³â ðåàá³ë³òàö³¿ º êëþ÷àìè äëÿ äîñÿãíåí-
íÿ ö³ëåé Êîíâåíö³¿.
³äïîâ³äàþ÷è íà Êîíâåíö³þ, ÂÎÎÇ òà Ñâ³òîâèé
áàíê â 2011 ðîö³ ï³äãîòóâàëè Âñåñâ³òíþ äîïîâ³äü
ç îáìåæåíü æèòòºä³ÿëüíîñò³8, ÿêà âïåðøå ñïèðà-
ëàñü íà íàóêîâ³ äîêàçè äëÿ îïèñó æèòòºâîãî äîñ-
â³äó òà ñòàíîâèùà ëþäåé ç îáìåæåííÿìè æèòòº-
ä³ÿëüíîñò³, òà íà ï³äñòàâ³ ÷îãî áóëè ðîçðîáëåí³
â³äïîâ³äí³ ðåêîìåíäàö³¿. Îäíèì ç îñíîâíèõ âèñ-
íîâê³â áóëî òå, ùî ïîøèðåí³ñòü îáìåæåíü æèòòº-
ä³ÿëüíîñò³ âèùà, í³æ î÷³êóâàëîñÿ (ñòàíîâèòü áëèçü-
êî 15% íàñåëåííÿ ñâ³òó). Ó Âñåñâ³òí³é äîïîâ³ä³ ç
îáìåæåíü æèòòºä³ÿëüíîñò³ ï³äêðåñëåíèé âíåñîê
ðåàá³ë³òàö³¿ äëÿ “äîñÿãíåííÿ òà ï³äòðèìêè îñîáîþ
îïòèìàëüíîãî ôóíêö³îíóâàííÿ â ïðîöåñ³ âçàºìî䳿
ç íàâêîëèøí³ì ñåðåäîâèùåì”. Äîïîâ³äü îïèñóº
“Ðåàá³ë³òàö³éíó ìåäèöèíó”, ÿê “ïîâ’ÿçàíó ç ïîêðà-
ùåííÿì ôóíêö³îíóâàííÿ ÷åðåç ä³àãíîñòèêó òà ë³êó-
âàííÿ ñòàí³â çäîðîâ’ÿ, çìåíøåííÿ ïîðóøåíü òà
çàïîá³ãàííÿ àáî ë³êóâàííÿ óñêëàäíåíü”, ³ öå âè-
ñâ³òëèëî ðîëü ë³êàð³â ³ç ñïåö³àëüíèìè çíàííÿìè â
îáëàñò³ ìåäè÷íî¿ ðåàá³ë³òàö³¿, ùî íàçèâàþòüñÿ
“ô³ç³àòðè, ðåàá³ë³òàö³éí³ ë³êàð³ àáî ôàõ³âö³ ç ô³çè÷-
íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè».  äîïîâ³ä³ òàêîæ
âèçíàíî, ùî “Ðåàá³ë³òàö³éíà ìåäèöèíà ïîêàçàëà ïî-
çèòèâí³ ðåçóëüòàòè, íàïðèêëàä, ó ïîë³ïøåíí³ ôóíêö³¿
ñóãëîá³â òà ê³íö³âîê, ìåíåäæìåíòó áîëþ, çàãîºíí³
ðàí òà ïñèõîñîö³àëüíîìó áëàãîïîëó÷÷³”.
Öÿ “íîâà” ïåðñïåêòèâà ðåàá³ë³òàö³¿ òà ÔÐÌ ï³ä-
êðåñëþºòüñÿ Ãëîáàëüíèì ïëàíîì ä³é ÂÎÎÇ ç îá-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß
ìåæåíü æèòòºä³ÿëüíîñò³ 2014-2021 ðîê³â, “Êðàùå
çäîðîâ’ÿ äëÿ âñ³õ ëþäåé ç îáìåæåííÿìè æèòòºä³-
ÿëüíîñò³”, ç ìåòîþ “ïîñèëåííÿ òà ðîçøèðåííÿ ðå-
àá³ë³òàö³¿, àá³ë³òàö³¿, äîïîì³æíèõ òåõíîëîã³é, ïîñëóã
äîïîìîãè òà ðåàá³ë³òàö³¿, ùî ïðîâîäèòüñÿ â ãðîìà-
äàõ». Îäíèì ³ç ïîêàçíèê³â óñï³õó äëÿ öèõ ö³ëåé º
“ê³ëüê³ñòü âèïóñêíèê³â íàâ÷àëüíèõ çàêëàä³â íà
10 000 ÷îëîâ³ê – çà ð³âíåì òà ñôåðîþ îñâ³òè”. Ó
öüîìó ïîêàçíèêó ÔÐÌ íåäâîçíà÷íî çàçíà÷àºòüñÿ9.
ϳä ÷àñ ï³äãîòîâêè ÁÊ ÂÎÎÇ â ëþòîìó 2017 ð.
çàïóñòèëà ³í³ö³àòèâó “Ðåàá³ë³òàö³ÿ 2030: çàêëèê äî
ä³é”10, â ÿê³é âçÿëè ó÷àñòü ïîíàä 200 ïðåäñòàâíèê³â
çàö³êàâëåíèõ ñòîð³í òà íà ÿêèé áóëè ïðåäñòàâëåí³
ðåêîìåíäàö³¿ ÂÎÎÇ ùîäî ðåàá³ë³òàö³¿ â ñèñòåìàõ
îõîðîíè çäîðîâ’ÿ. Ö³ ³í³ö³àòèâè ïðèçíà÷åí³ äëÿ òîãî
ùîá:
– ïðèâåðíóòè óâàãó äî çðîñòàþ÷èõ íåçàäîâîëåíèõ
ïîòðåá ó ðåàá³ë³òàö³¿ â ñâ³ò³;
– âèä³ëèòè ðîëü ðåàá³ë³òàö³¿ ó äîñÿãíåíí³ Ö³ëåé
Ñòàëîãî Ðîçâèòêó, çàïðîïîíîâàíèõ Îðãàí³çà-
ö³ºþ Îá’ºäíàíèõ Íàö³é;
– çàêëèêàòè äî ñêîîðäèíîâàíèõ òà óçãîäæåíèõ
ãëîáàëüíèõ çàõîä³â ùîäî ïîñèëåííÿ ðåàá³ë³òàö³¿
â ñèñòåìàõ îõîðîíè çäîðîâ’ÿ.
Çàãàëüíèìè äëÿ âñ³õ öèõ ³í³ö³àòèâ ñòàëè ì³æíà-
ðîäíî óçãîäæåí³ ö³ë³ äëÿ ïîêðàùåííÿ ïîñëóã ç ðåà-
á³ë³òàö³¿ â ñôåð³ îõîðîíè çäîðîâ’ÿ, çàäëÿ íàäàííÿ
ìîæëèâîñò³ ëþäÿì ç³ ñòàíàìè çäîðîâ’ÿ, ÿê³ çàçíà-
þòü, àáî ìîæóòü çàçíàòè îáìåæåíü æèòòºä³ÿëü-
íîñò³, äîñÿãòè òà ï³äòðèìàòè îïòèìàëüíå ôóíêö³î-
íóâàííÿ ó âçàºìî䳿 ç íàâêîëèøí³ì ñåðåäîâèùåì –
íàâ÷àííÿ ë³êàð³â ÔÐÌ òà ïîë³ïøåííÿ ÿêîñò³ äîïî-
ìîãè. ªâðîïåéñüê³ Îðãàíè ÔÐÌ ïðèéíÿëè ö³ ö³ë³, ³
òðåòº âèäàííÿ ÁÊ ç ÔÐÌ â ªâðîï³ ìຠçà ìåòó
ñïðèÿòè äîñÿãíåííþ öèõ ö³ëåé.
Òàêèì ÷èíîì, ìåòà ÁÊ ïîëÿãຠâ âèçíà÷åíí³ ç
ºâðîïåéñüêî¿ òî÷êè çîðó ðîáîòè ñïåö³àëüíîñò³ ÔÐÌ
òà ë³êàð³â ÔÐÌ ó:
– ì³íëèâîìó ñâ³ò³ ñèñòåì îõîðîíè çäîðîâ’ÿ òà
ñêîðî÷åííÿ ðåñóðñ³â;
– ðåàãóâàíí³ òà âíåñêó äî ìåäè÷íîãî ïðîãðåñó òà
òåõíîëîã³÷íèõ ³ííîâàö³é;
– ðîçðîáêó ñòðàòåã³é âèð³øåííÿ çàâäàíü íàóêîâî-
òåõí³÷íîãî ïðîãðåñó;
– ðîáîò³ ç ì³íëèâèìè ïåðñïåêòèâàìè îáìåæåíü
æèòòºä³ÿëüíîñò³;
– ñïðèÿíí³ òà ïîëåãøåíí³ ñàìîñò³éíîñò³ òà ó÷àñò³
ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ â ïîâñÿê-
äåííîìó æèòò³;
– ñëóãóâàíí³ äèäàêòè÷íèì äîâ³äíèêîì äëÿ ïðàê-
òèêè ÔÐÌ òà àêàäåì³÷íîãî æèòòÿ ìîëîäèõ ïðî-
ôåñ³îíàë³â îõîðîíè çäîðîâ’ÿ (îñîáëèâî ë³êàð³â
ïðîòÿãîì íàâ÷àííÿ).
Îòæå, ÁÊ ìຠáàãàòîãðàíí³ ö³ííîñò³, ÿê³ ïî÷è-
íàþòüñÿ ç îñâ³òíüî¿ ðîë³ äëÿ ë³êàð³â ÔÐÌ, ùî íà-
9
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
â÷àþòüñÿ, äî îá’ºäíóþ÷î¿ ôóíêö³¿ äëÿ ºâðîïåé-
ñüêèõ äåðæàâ òà äëÿ ïîë³òè÷íî¿ âçàºìî䳿 ì³æ óðÿ-
äàìè ªâðîïè òà ªÑ. Öå âàæëèâî äëÿ ÔÐÌ, ðîëü
ÿêî¿ ïîäåêóäè íå äî ê³íöÿ º çðîçóì³ëîþ, îñîáëèâî
ó ñïðèéíÿòò³ òèõ, õòî çíàõîäèòüñÿ çà ìåæàìè ö³º¿
ñïåö³àëüíîñò³. ÔÐÌ ïîñò³éíî ñï³âïðàöþº ç ³íøèìè
ñïåö³àëüíîñòÿìè òà ³íøèìè ôàõ³âöÿìè ðåàá³ë³òàö³¿
â ä³ÿëüíîñò³ â ñôåð³ îõîðîíè çäîðîâ’ÿ, îñâ³òè òà
íàóêîâèõ äîñë³äæåíü. Öÿ êíèãà ñïðÿìîâàíà íà
ïîÿñíåíí³ ðîë³ ÔÐÌ ó ñï³âïðàö³ ç ³íøèìè:
– ìåäè÷íèìè ñïåö³àëüíîñòÿìè, ùî ë³êóþòü
ïàö³ºíò³â ç³ ñòàíàìè çäîðîâ’ÿ, ÿê³ ïåðåòèíàþòü
ìåæ³ äèñöèïë³í ç óðàõóâàííÿì ôîêóñó ÔÐÌ íà
àêòèâíîñò³ òà ó÷àñò³;
– ôàõ³âöÿìè ðåàá³ë³òàö³¿, ÿê³ òàêîæ çàéìàþòüñÿ
ïðîáëåìàìè àêòèâíîñò³ òà ó÷àñò³, ÿê³ çàçíàþòü
ïàö³ºíòè, ïðè òîìó çáåð³ãàþ÷è ñâîþ óí³êàëüíó
ìåäè÷íó ðîëü ó ä³àãíîñòèö³, ôóíêö³îíàëüíîìó
îö³íþâàíí³, ïðîãíîçóâàíí³ òà óïðàâë³ííÿ êîìàí-
äîþ.
ÔÐÌ – öå íåçàëåæíà ïåðâèííà ìåäè÷íà ñïå-
ö³àëüí³ñòü, ùî íàÿâíà ïðàêòè÷íî ó âñ³õ êðà¿íàõ ªâðî-
ïè, ç ñïåöèô³÷íèìè ïðîôåñ³éíèìè êîìïåòåíòíîñòÿ-
ìè òà ñï³ëüíèìè ïåðåäóìîâàìè òà ³ñòîð³ºþ. Á³ëüø
òîãî, ÔÐÌ º ì³æíàðîäíî âèçíàíîþ òà º ïàðòíåðîì
ïðîâ³äíèõ ì³æíàðîäíèõ îðãàí³â, ó òîìó ÷èñë³ ÂÎÎÇ,
ùî çàáåçïå÷óº âïëèâ ÔÐÌ íà ä³ÿëüí³ñòü ÎÎÍ òà
ÂÎÎÇ. Ç îãëÿäó íà öå, ïóáë³êàö³ÿ ÁÊ âñ³ìà ªâðî-
ïåéñüêèìè Îðãàíàìè ÔÐÌ º ö³ííîþ äëÿ ëþäåé
(îñîáëèâî ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³), ÿê³
æèâóòü â ªâðîï³, äëÿ ÔÐÌ, ÿê ñïåö³àëüíîñò³, äëÿ
îðãàí³çàòîð³â îõîðîíè çäîðîâ’ÿ òà ïîë³òèê³â, à òàêîæ
äëÿ ñóñï³ëüñòâà â ö³ëîìó.
Âñ³ ö³ êîíöåïö³¿, à òàêîæ äåÿê³ íîâ³ êîíöåïö³¿
áóäóòü ðîçøèðåí³ â öüîìó îñòàííüîìó âèäàíí³ ÁÊ.
Öå âèäàííÿ ÁÊ º íàáàãàòî á³ëüø “êîëåêòèâíèì
çóñèëëÿì” ó ïîð³âíÿíí³ ç ïîïåðåäí³ìè âèäàííÿìè –
ÿê çàçíà÷åíî ðàí³øå, áóëî ñòâîðåíî Àëüÿíñ ªâðî-
ïåéñüêèõ Îðãàí³â ÔÐÌ, òà éîãî ñï³ëüí³ çóñèëëÿ
ïðèâåëè öå íîâå âèäàííÿ ÁÊ äî óñï³õó. ²ñíóº òà-
êîæ íîâà ìåòîäîëîã³÷íà ãëàâà, â ÿê³é îêðåñëåíî
ìåòîäîëîã³þ, ÿêà êåðóâàëà ðîçðîáêîþ çì³ñòó êîæ-
íî¿ ãëàâè ÁÊ. Á³ëüø òîãî, ³ñòîðè÷íà ãëàâà êíèãè
â³äîáðàæຠâèùåçãàäàí³ ðîçðîáêè òà ââîäÿòüñÿ
êîíöåïòóàëüí³ îñíîâè ÔÐÌ ÿê ñïåö³àëüíîñò³.
ÁÊ ïðåäñòàâëåíà ó ÷îòèðüîõ ÷àñòèíàõ (îñíîâè
ÔÐÌ, ¿¿ îðãàí³çàö³ÿ, ïðàêòèêà â ªâðîï³ òà âèñíîâ-
êè) ç äîäàòêàìè (âêëþ÷àþ÷è ðîçä³ë ìåòîä³â). ÁÊ
ïî÷èíàºòüñÿ ç áàçîâèõ âèçíà÷åíü (êîíöåïö³ÿ òà
ñïåö³àëüí³ñòü), ï³ñëÿ ÷îãî ðîçãëÿäຠàêòóàëüí³ñòü
ðåàá³ë³òàö³¿ äëÿ ëþäåé ç ñòàíàìè, ùî ïðèçâîäÿòü
äî îáìåæåíü æèòòºä³ÿëüíîñò³ òà äëÿ ñóñï³ëüñòâà
(íàïð. ÷îìó öå ïîòð³áíî). Ïîò³ì ÁÊ çíàéîìèòü ç
çàãàëüíîþ ðåàá³ë³òàö³þ, ÿêà íå º ñïåöèô³÷íî ìå-
äè÷íîþ, òà äàë³ ïåðåõîäèòü äî îïèñó ÔÐÌ –
10 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ìåäè÷íî¿ ñïåö³àëüíîñò³, ïðèñâÿ÷åíî¿ ðåàá³ë³òàö³¿
ïàö³ºíò³â òà ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³. Âèçíà÷åííÿ ÔÐÌ, ÿê ïåðâèííî¿ ìåäè÷íî¿
ñïåö³àëüíîñò³ (îñíîâí³ êîíöåïö³¿), íàäàíî ðàçîì ç
¿¿ ðîçâèòêîì (çâ³äêè íàäõîäèòü ÔÐÌ) òà îðãàí³çà-
ö³ºþ (ä³ÿëüí³ñòü ÔÐÌ òà ¿¿ ïðåäñòàâíèöòâî) ó
ªâðîï³. Ïåðåõîäÿ÷è äî ïðàêòèêè, îáãîâîðþþòüñÿ
îñíîâè ÔÐÌ (çíàííÿ, íàâè÷êè òà âì³ííÿ ë³êàð³â
ÔÐÌ), ñôåðà êîìïåòåíòíîñòåé (ÔÐÌ íà ïðàêòèö³)
òà ì³ñöå â ñèñòåì³ îõîðîíè çäîðîâ’ÿ òà ñóñï³ëüñòâ³.
Ïåðåä òèì, ÿê çðîáèòè âèñíîâêè ïðî ïîäàëüøèé
øëÿõ âïåðåä äëÿ ÔÐÌ â ªâðîï³ (âèêëèêè òà ïåð-
ñïåêòèâè íà ìàéáóòíº) òàêîæ ïîâ³äîìëÿºòüñÿ ïðî
îñâ³òó ç ÔÐÌ â ªâðîï³ (ôîðìóâàííÿ ìàéáóòíüî-
ãî) òà ïðî íàóêîâ³ äîñë³äæåííÿ ó ñôåð³ ÔÐÌ (ïðî-
áëåìè òà îñîáëèâîñò³).
Öå âèäàííÿ ÁÊ º ùå îäíèì âàæëèâèì êðîêîì
äëÿ ìàéáóòíüîãî ñïåö³àëüíîñò³ ÔÐÌ â ªâðîï³ òà
çà ¿¿ ìåæàìè. Öå º ðåçóëüòàòîì ðîáîòè íàñòóïíèõ
çàö³êàâëåíèõ ñòîð³í (òàêîæ äèâ. ðîçä³ë ïîäÿê â
äîäàòêó)
– ³í³ö³àòèâà òà àâòîðñòâî 4-õ ªâðîïåéñüêèõ
Îðãàí³â ÔÐÌ, ÿê³ îá’ºäíàëèñÿ â ºäèíèé ïðîäóê-
òèâíèé Àëüÿíñ,
– êîîðäèíàö³ÿ ðîáîòè 11 ðåäàêòîð³â,
– çóñèëëÿ 38 ïåðøèõ àâòîð³â òà 63 ñï³âàâòîð³â äëÿ
ï³äãîòîâêè 62 îêðåìèõ ïðîïîçèö³é,
– äîáðîâ³ëüíà ðîáîòà 38 âíóòð³øí³õ òà 39
çîâí³øí³õ ðåöåíçåíò³â,
– çà 30 ì³ñÿö³â ðîáîòè áóâ äîñÿãíóòèé êîíñåíñóñ
ì³æ 241 äåëåãàòàìè òà íàóêîâöÿìè ç 36 ºâðî-
ïåéñüêèõ êðà¿í.
Ðåäàêòîðè 3-ãî âèäàííÿ Á³ëî¿ Êíèãè
Stefano Negrini, Pedro Cantista,
Maria Gabriella Ceravolo,
Nicolas Christodoulou, Alain Delarque,
Christoph Gutenbrunner, Carlotte Kiekens,
Sasa Moslavac, Enrique Varela-Donoso,
Anthony B Ward, Mauro Zampolini
Êîðîòêèé çì³ñò
Îãëÿä
Òðåòº âèäàííÿ Á³ëî¿ êíèãè (ÁÊ) ç ô³çè÷íî¿ òà
ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîá-
ëåíî Àëüÿíñîì ªâðîïåéñüêèõ Îðãàí³â ÔÐÌ, âêëþ-
÷àþ÷è ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ªÀÐÌ), ªâðîïåéñüêå Òîâàðèñòâî ÔÐÌ
(ªÒÔÐvÌ), Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó
Ìåäè÷íèõ Ñïåö³àë³ñò³â (ªÑÌÑ) òà ªâðîïåéñüêèé
êîëåäæ ÔÐÌ (â îñîá³ Ðàäè ÔÐÌ ªÑÌÑ). Öå äî-
â³äíèê äëÿ ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà áóëà ïðè-
çíà÷åíà äëÿ íàäàííÿ âè÷åðïíî¿ ³íôîðìàö³¿ ïðî
ÔÐÌ, ÿêà º àêòóàëüíîþ äëÿ ë³êàð³â ÔÐÌ, ³íøèõ
¹2(2) *2018

ôàõ³âö³â ãàëóç³ îõîðîíè çäîðîâ’ÿ, îðãàí³çàòîð³â
îõîðîíè çäîðîâ’ÿ òà ³íøèõ çàö³êàâëåíèõ ñòîð³í, ó
òîìó ÷èñë³ òèõ, ùî çíàõîäÿòüñÿ ó ªâðîïåéñüêèõ
íàö³îíàëüíèõ óðÿäàõ. Âîíà òàêîæ ³íôîðìóº ºâðî-
ïåéñüê³ äåðæàâí³ îðãàíè òà øèðîêó ãðîìàäñüê³ñòü.
ÁÊ ³íôîðìóº ïðî âàæëèâ³ñòü ÔÐÌ ÿê äëÿ îêðå-
ìîãî ïàö³ºíòà àáî îñîáè, ùî çàçíàëà îáìåæåíü
æèòòºä³ÿëüíîñò³, òàê ³ äëÿ ñóñï³ëüñòâà â ö³ëîìó.
Âîíà îïèñóº, ÿêèì ÷èíîì ÔÐÌ, ÿêà º ïåðâèííîþ
ìåäè÷íîþ ñïåö³àëüí³ñòþ, ïðåäñòàâëåíà ïðàêòè÷-
íî â óñ³õ êðà¿íàõ ªâðîïè, ìຠñïåöèô³÷í³ áàçîâ³
êîìïåòåíòíîñò³ òà çàãàëüí³ ïåðåäóìîâè òà ³ñòîð³þ
â ªâðîï³.
Ñôåðà çàñòîñóâàííÿ ÔÐÌ òà ¿¿ ðîëü ó ðåàá³ë³-
òàö³¿ ìàþòü ì³öíó îñíîâó â äîêóìåíòàõ Îðãàí³çàö³¿
Îá’ºäíàíèõ Íàö³é (ÎÎÍ) òà Âñåñâ³òíüî¿ îðãàí³-
çàö³¿ îõîðîíè çäîðîâ’ÿ (ÂÎÎÇ), ÿê, íàïðèêëàä,
̳æíàðîäíà êëàñèô³êàö³ÿ ôóíêö³îíóâàííÿ, îáìå-
æåííÿ æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ) (2001),
Êîíâåíö³ÿ ÎÎÍ ïðî ïðàâà ëþäåé ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ (2006), Âñåñâ³òíÿ äîïîâ³äü ç îá-
ìåæåíü æèòòºä³ÿëüíîñò³ (2011), Ãëîáàëüíèé Ïëàí
ä³é ÂÎÎÇ ç îáìåæåíü æèòòºä³ÿëüíîñò³ íà 2014-
2021 ðîêè (2014) òà ³í³ö³àòèâà ÂÎÎÇ “Ðåàá³ë³òàö³ÿ
2030 ðîêó: çàêëèê äî ä³é” (2017). Îðãàí³çàö³¿ ÔÐÌ
âèçíàí³ íà ì³æíàðîäíîìó ð³âí³ òà ïðàöþþòü, ÿê
ïàðòíåð âåëèêèõ ì³æíàðîäíèõ îðãàí³çàö³é, òàêèõ ÿê
ÂÎÎÇ.
Á³ëà êíèãà ìຠ÷îòèðè ÷àñòèíè ³ ðîçïîä³ëåíà íà
11 ðîçä³ë³â òà äîäàòê³â (ùî âêëþ÷àþòü ìåòîäî-
ëîã³÷í³ íîòàòêè). Âîíà ïî÷èíàºòüñÿ ç ïîÿñíåííÿ îñ-
íîâíèõ âèçíà÷åíü òà êîíöåïö³é ÔÐÌ, àêòóàëüíîñò³
ÔÐÌ, äëÿ ëþäåé òà ñóñï³ëüñòâà, âèçíà÷åíü îáìå-
æåíü æèòòºä³ÿëüíîñò³ òà ðåàá³ë³òàö³¿. ÁÊ ïðåäñòàâ-
ëÿº ÔÐÌ ÿê ïåðâèííó ìåäè÷íó ñïåö³àëüí³ñòü, ¿¿
ðîçâèòîê òà ¿¿ îðãàí³çàö³¿ â ªâðîï³. Îáãîâîðþþòü-
ñÿ çíàííÿ òà íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà ¿õ êîì-
ïåòåíòíîñòåé, ¿õ ïîçèö³ÿ òà ðîëü ó ñèñòåìàõ îõî-
ðîíè çäîðîâ’ÿ. Êð³ì òîãî, îïèñàí³ ïðèíöèïè îñâ³òè
òà íàâ÷àííÿ, à òàêîæ íàóêà òà äîñë³äæåííÿ. Íà-
ðåøò³, àëå íå ìåíø âàæëèâî, âèð³øåí³ âèêëèêè òà
ìàéáóòí³ ïåðñïåêòèâè ÔÐÌ â ªâðîï³.
Âèçíà÷åííÿ òà îñíîâí³ ïîíÿòòÿ ÔÐÌ
ÔÐÌ – öå ïåðâèííà ìåäè÷íà ñïåö³àëüí³ñòü, ùî
â³äïîâ³äຠçà îñâ³òó òà íàâ÷àííÿ ïàö³ºíò³â òà íà-
äàâà÷³â ïîñëóã îõîðîíè çäîðîâ’ÿ, çì³öíåííÿ çäî-
ðîâ’ÿ, ïðîô³ëàêòèêó, ìåäè÷íó ä³àãíîñòèêó, ôóíêö³-
îíàëüíå îö³íþâàííÿ, ë³êóâàííÿ òà ðåàá³ë³òàö³éíèé
ìåíåäæìåíò äëÿ ëþäåé áóäü-ÿêîãî â³êó, ÿê³ çàç-
íàëè ñòàí³â çäîðîâ’ÿ, ùî ïðèçâîäÿòü äî îáìåæåíü
æèòòºä³ÿëüíîñò³ òà ¿õ ñóïóòí³õ çàõâîðþâàíü. ˳êàð³
ÔÐÌ ë³êóþòü ñòàíè çäîðîâ’ÿ, ïîðóøåííÿ ô³çè÷íèõ,
ïñèõ³÷íèõ òà ï³çíàâàëüíèõ ôóíêö³é, à òàêîæ îáìå-
æåííÿ àêòèâíîñò³. ˳êàð³ ÔÐÌ ìàþòü çà ìåòó ïî-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß
êðàùåííÿ ó÷àñò³ òà ÿêîñò³ æèòòÿ ñâî¿õ ïàö³ºíò³â.
Öå òàêîæ âêëþ÷ຠâ ñåáå ïîë³ïøåííÿ çäîðîâî¿
ïîâåä³íêè òà ñïðèÿííÿ ïîçèòèâíîìó âïëèâó îñîáè-
ñòèõ ôàêòîð³â òà ôàêòîð³â íàâêîëèøíüîãî ñåðåäî-
âèùà íà ôóíêö³îíóâàííÿ.
Ïðîô³ëü ÔÐÌ âêëþ÷ຠâ ñåáå íàñòóïíå:
– ÔÐÌ – öå ìåäè÷íà ñïåö³àëüí³ñòü, îð³ºíòîâàíà
íà ïåðñîíó òà ôóíêö³îíóâàííÿ (âñóïåðå÷ ñïå-
ö³àëüíîñòÿì, îð³ºíòîâàíèì íà îðãàíè òà õâîðî-
áè, àáî ñïåö³àëüíîñòÿì, ùî ôîêóñóþòüñÿ íà êîí-
êðåòíèõ â³êîâèõ ãðóïàõ).
– ˳êàð³ ÔÐÌ ìàþòü ìåäè÷í³ îáîâ’ÿçêè òà äî-
äàòêîâ³ êîìïåòåíòíîñò³ ïðè îðãàí³çàö³¿ ôóíêö³-
îíàëüíîãî îö³íþâàííÿ.
– ÔÐÌ ë³êàð³ ìîæóòü áåçïîñåðåäíüî çàáåçïå÷ó-
âàòè ë³êóâàííÿ òà / àáî î÷îëþâàòè ìóëüòèïðî-
ôåñ³éíó ðåàá³ë³òàö³éíó êîìàíäó, ÿêà ïðàöþº
ñï³ëüíî ç ³íøèìè ñïåö³àëüíîñòÿìè.
– ÔÐÌ ìຠáàãàòîìîäàëüíèé ï³äõ³ä, âêëþ÷àþ÷è
øèðîêèé ñïåêòð ³íñòðóìåíò³â äëÿ ë³êóâàííÿ
(âêëþ÷àþ÷è ë³êè, ô³çè÷í³ âïðàâè, ô³çè÷í³ ìî-
äàëüíîñò³ òà ³íø³ ðåàá³ë³òàö³éí³ âòðó÷àííÿ,
äåÿê³ ç ÿêèõ íàäàþòüñÿ ³íøèìè ôàõ³âöÿìè ðåà-
á³ë³òàö³¿).
– ÔÐÌ ë³êóº ñòàíè çäîðîâ’ÿ ³íäèâ³äóóìà, çîñå-
ðåäæóþ÷è óâàãó íà çìåíøåíí³ ïîðóøåíü òà
îáìåæåíü àêòèâíîñò³, ç òèì ùîá ðîçøèðþâàòè
ìîæëèâîñò³ ïàö³ºíò³â äîñÿãòè ïîâíî¿ ó÷àñò³.
– ÔÐÌ ìຠòðàíâåðçàëüíó ðîëü ³ ñï³âïðàöþº ç
óñ³ìà ³íøèìè ñïåö³àëüíîñòÿìè.
ÔÐÌ ôîêóñóºòüñÿ íà ïåðñîí³, à íå íà êîíêðåò-
íîìó çàõâîðþâàíí³ ÷è çàêëàä³, òîìó ë³êàð³ ÔÐÌ
ñï³âïðàöþþòü ç áàãàòüìà ³íøèìè ìåäè÷íèìè
ñïåö³àë³ñòàìè òà ôàõ³âöÿìè îõîðîíè çäîðîâ’ÿ òà
ìàþòü â³äïîâ³äí³ ðîë³ ó ð³çíèõ çàêëàäàõ îõîðîíè
çäîðîâ’ÿ (íàïð. ãîñòð³ òà / àáî ï³äãîñòð³ ðåàá³ë³-
òàö³éí³ ë³êàðí³, ðåàá³ë³òàö³éí³ öåíòðè, àìáóëàòîðí³
çàêëàäè, çàêëàäè â ãðîìàäàõ). ˳êàð³ ÔÐÌ äáàþòü
ïðî îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà ïðî
ïàö³ºíò³â ç äîâãîòðèâàëèìè ñòàíàìè çäîðîâ’ÿ, àëå
é òàêîæ ïðî ïàö³ºíò³â ç ãîñòðèìè ñòàíàìè äëÿ çà-
ïîá³ãàííÿ ðîçâèòêó âòîðèííèõ ïîðóøåíü.
ßê íåùîäàâíî áóëî ï³äêðåñëåíî ÂÎÎÇ ÷åðåç
“Ðåàá³ë³òàö³ÿ 2030 – çàêëèê äî ä³é”, àêòóàëüí³ñòü
ÔÐÌ äëÿ ñóñï³ëüñòâà çá³ëüøèëàñü âíàñë³äîê ñòà-
ð³ííÿ íàñåëåííÿ òà çðîñòàþ÷î¿ ê³ëüêîñò³ ëþäåé, ùî
çàçíàëè îáìåæåíü æèòòºä³ÿëüíîñò³. Òàêèì ÷èíîì,
áóäü-ÿêå ïëàíóâàííÿ ïîñëóã ìຠâðàõîâóâàòè òÿ-
ãàð îáìåæåíü æèòòºä³ÿëüíîñò³ â ñóñï³ëüñòâ³ òà
âêëþ÷àòè ïîñëóãè ÔÐÌ íà âñ³õ ð³âíÿõ äîïîìîãè.
Îðãàí³çàö³ÿ òà ³ñòîð³ÿ ÔÐÌ â ªâðîï³
²ñòîðè÷íî, ÔÐÌ ôîðìóâàëàñÿ ç äåÿêèõ îñíîâ-
íèõ íàïðÿìê³â ïî âñ³é ªâðîï³. Îäèí ç íèõ – âèêî-
ðèñòàííÿ ô³çè÷íèõ àãåíò³â (âîäà, òåïëî, õîëîä,
11
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ìàñàæ, ìàí³ïóëÿö³¿ ç ñóãëîáàìè, ô³çè÷í³ âïðàâè
òîùî) (Ô³çè÷íà Ìåäèöèíà). ²íøèé – ïðàêòèêà ðå-
àá³ë³òàö³¿, ÿêà íàáóëà âàæëèâîñò³ ÷åðåç âèæèâàí-
íÿ ïîðàíåíèõ ó Äðóã³é ñâ³òîâ³é â³éí³, à òàêîæ ð³çíèõ
åï³äåì³é (íàïð., ïîë³î쳺ë³òó) (Ðåàá³ë³òàö³éíà Ìå-
äèöèíà). Â äåÿêèõ êðà¿íàõ âîíà ðîçâèâàëàñü â
çâ’ÿçêó ç ³íøèìè ìåäè÷íèìè ñïåö³àëüíîñòÿìè,
òàêèìè, ÿê íåâðîëîã³ÿ, ðåâìàòîëîã³ÿ, îðòîïåä³ÿ,
ðàä³îëîã³ÿ, à òàêîæ êàðä³îëîã³ÿ, ïíåâìîëîã³ÿ òà
ïåä³àòð³ÿ, ïðè÷îìó ñïåöèô³êà ïåðø çà âñå ïîëÿãà-
ëà ó ðîçãëÿä³ ôóíêö³îíóâàííÿ ïàö³ºíò³â ç öèìè ñòà-
íàìè çäîðîâ’ÿ.  ³íøèõ êðà¿íàõ âîíà ïî÷àëàñÿ â
ñïåöèô³÷íèõ çàêëàäàõ, òàêèõ ÿê áàëüíåîëîã³ÿ òà
ñïîðòèâíà ìåäèöèíà. Ñüîãîäí³, çàâäÿêè ñï³ëüíèì
ðèñàì ñåðåä óñ³õ öèõ ãàëóçåé, âîíè ç³éøëèñü â
ºäèíó áàãàòîñòîðîííþ ñïåö³àëüí³ñòü ÔÐÌ.
Äëÿ ºäèíîãî âèçíà÷åííÿ òà ïîçèö³îíóâàííÿ â
ªâðîï³ áóëè ñòâîðåí³ ð³çí³ îðãàí³çàö³¿ ÔÐÌ: ªÀÐÌ,
ªÊÔÐÌ, ªÒÔÐÌ; òà ñåêö³ÿ ÔÐÌ ªÑÌÑ.  äà-
íèé ÷àñ â ªâðîï³ ³ñíóº òàêå ºäèíå âèçíà÷åííÿ ñïå-
ö³àëüíîñò³, ÿêå óçãîäæóºòüñÿ ç ì³æíàðîäíî âèçíà-
íèì îïèñîì ÔÐÌ (íà îñíîâ³ ìîäåë³ ÌÊÔ).
Êð³ì òîãî, ñòâîðåí³ ðåã³îíàëüí³ ôîðóìè, òàê³ ÿê
Ñåðåäçåìíîìîðñüêèé ôîðóì ÔÐÌ òà Ôîðóì ÔÐÌ
Áàëò³éñüêîãî òà ϳâí³÷íîãî ìîðÿ, â á³ëüøîñò³ ºâðî-
ïåéñüêèõ êðà¿í ³ñíóþòü íàö³îíàëüí³ òîâàðèñòâà
ÔÐÌ. Âîíè â³ä³ãðàþòü âàæëèâó ðîëü ó ðîçâèòêó
ÔÐÌ íà ð³âí³ âçàºìî䳿 ªâðîïè ç ñóñ³äí³ìè ðåã³î-
íàìè, à òàêîæ íà íàö³îíàëüíîìó ð³âí³. ªâðîïåéñüê³
àñîö³àö³¿ ÔÐÌ òàêîæ â³ä³ãðàþòü âàæëèâó ðîëü ó
â³äïîâ³äíèõ çàõîäàõ ó âñüîìó ñâ³ò³.
Á³ëüøå òîãî, äîñë³äæåííÿ â îáëàñò³ ÔÐÌ áóëè
çíà÷íî ïîêðàùåí³, à ê³ëüê³ñòü æóðíàë³â ÔÐÌ çðîñ-
ëà (áàãàòî ç íèõ ³íäåêñóþòüñÿ â ì³æíàðîäíèõ áà-
çàõ äàíèõ òà ç âïëèâîâèì ³ìïàêò-ôàêòîðîì), à òà-
êîæ ðîçâèëèñü íàóêîâ³ êîíãðåñè òà êóðñè. Íàðåøò³,
àëå íå â îñòàííþ ÷åðãó, íåùîäàâíº ñòâîðåííÿ
Êîêðàí³âñüêî¿ ðåàá³ë³òàö³éíî¿ ñôåðè òàêîæ äàñòü
çíà÷íèé ïîøòîâõ ö³é ïåðâèíí³é ìåäè÷í³é ñïåö³àëü-
íîñò³.
Ïðàêòèêà ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè â ªâðîï³
Ç ô³ç³îëîã³÷íî¿ òî÷êè çîðó, ôóíäàìåíòàëüí³
ïðèíöèïè ÔÐÌ âêëþ÷àþòü ô³çè÷í³ òà ïîâåä³íêîâ³
ìåõàí³çìè, âêëþ÷àþ÷è:
– ïðîöåñè ðåïàðàö³¿ òà ôóíêö³îíàëüíî¿ àäàïòàö³¿
(âêëþ÷àþ÷è ðåãåíåðàö³þ òêàíèí, ïîë³ïøåííÿ
ôóíêö³îíàëüíî¿ ñïðîìîæíîñò³, òðåíóâàëüí³ ïðî-
öåñè òîùî), à òàêîæ ïðîöåñè ï³äòðèìêè â³äíîâ-
ëåííÿ;
– ïðîöåñè íàâ÷àííÿ òà ïîâåä³íêîâ³ çì³íè (ó òîìó
÷èñë³ íàâ÷àííÿ ïàö³ºíò³â òà òðåíóâàííÿ íîâèì
ìîòîðíèì òà ïîâåä³íêîâèì ñòðàòåã³ÿì);
12 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
– êîìïåíñàòîðí³ ïðîöåñè íà ô³çè÷íîìó, ðîçóìî-
âîìó ³ ³íòåëåêòóàëüíîìó ð³âíÿõ, à òàêîæ äî-
ïîì³æí³ òåõíîëî㳿 òà àäàïòàö³ÿ ñåðåäîâèùà.
Êð³ì òîãî, ë³êàð³ ÔÐÌ ìàþòü íàâè÷êè óïðàâ-
ë³ííÿ òà â³ä³ãðàþòü ïåâíó ðîëü ó ï³äòðèìö³ ëþäåé
äëÿ óïðàâë³ííÿ ñâî¿ìè ðåñóðñàìè ç ìåòîþ äîñÿã-
íåííÿ îïòèìàëüíî¿ ó÷àñò³ (âêëþ÷àþ÷è íàäàííÿ
ïîðàä ñâî¿ì ñ³ì’ÿì òà äîãëÿäà÷àì). Êð³ì òîãî,
ë³êàð³ ÔÐÌ ìàþòü âèñîêèé ð³âåíü êîìóí³êàòèâíèõ
íàâè÷îê, ùîá íàâ÷àòè, ³íôîðìóâàòè òà òðåíóâàòè
ïàö³ºíò³â òà ¿õ ðîäè÷³â.
Êë³í³÷íó ðîáîòó ë³êàð³â ÔÐÌ ìîæíà îõàðàêòå-
ðèçóâàòè ÿê “ìåäèöèíà ôóíêö³îíóâàííÿ”. ¯¿ îñíîâ-
íà ñòðàòåã³ÿ îõîðîíè çäîðîâ’ÿ – öå ðåàá³ë³òàö³éíà,
ñïðÿìîâàíà íà îïòèì³çàö³þ ôóíêö³îíóâàííÿ â ñâ³òë³
ñòàí³â çäîðîâ’ÿ. Ïðîòå, ë³êàð³ ÔÐÌ òàêîæ âèêîðè-
ñòîâóþòü ë³êóâàëüíó (ë³êóâàííÿ õâîðîáè), ïðîô³ëàê-
òè÷íó (ïðîô³ëàêòèêà õâîðîáè òà / àáî óñêëàäíåíü
òà ïðîãðåñóâàííÿ) òà ï³äòðèìóþ÷ó ñòðàòå㳿 (ñïðÿ-
ìîâàí³ íà ï³äòðèìêó îïòèìàëüíîãî ôóíêö³îíóâàííÿ).
Êë³í³÷í³ ïðîöåñè ÔÐÌ ñë³äóþòü çà òàê çâàíèì ðåà-
á³ë³òàö³éíèì öèêëîì (âñ³ ïàö³ºíòè ïåðåä íàäàííÿì
âòðó÷àííÿ ïîòðåáóþòü ïðîâåäåííÿ îö³íþâàííÿ ç
âèçíà÷åííÿì ¿õ ³íäèâ³äóàëüíèõ ö³ëåé; íàïðèê³íö³,
áóäå ïðîâåäåíà îö³íêà äëÿ âèçíà÷åííÿ, ÷è äîñÿãíóâ
ïàö³ºíò âñüîãî, ùî ïîòðåáóâàâ, àáî, çà íåîáõ³äíîñò³,
ðåàá³ë³òàö³éíèé öèêë ïî÷èíàºòüñÿ çíîâó)
Ñïåêòð çàõâîðþâàíü, ùî ë³êóþòüñÿ ë³êàðÿìè
ÔÐÌ, íàäçâè÷àéíî øèðîêèé, îñê³ëüêè áàãàòî
ñòàí³â çäîðîâ’ÿ ïîâ’ÿçàí³ ç ïåâíîþ ôîðìîþ îáìå-
æåíü æèòòºä³ÿëüíîñò³. Öå âêëþ÷ຠçàõâîðþâàííÿ
ì’ÿçîâî-ñêåëåòíî¿, íåðâîâî¿, öèðêóëÿòîðíî¿, ðåñï³-
ðàòîðíî¿, ñå÷îñòàòåâî¿ ñèñòåì, à òàêîæ øê³ðè òà
òðàâíîãî òðàêòó. Êë³í³÷íà ä³ÿëüí³ñòü ÔÐÌ òàêîæ
ñòîñóºòüñÿ äåÿêèõ íàéá³ëüø ïîøèðåíèõ ïðîáëåì
â³ä çàõâîðþâàíü, òàêèõ ÿê çíåðóõîìëåííÿ, ñïàñ-
òè÷í³ñòü, á³ëü, ïîðóøåííÿ êîìóí³êàö³¿ òà ³íø³.
ijàãíîç ó ÔÐÌ – öå êîìá³íàö³ÿ ìåäè÷íîãî ä³àã-
íîçó (ä³àãíîç çàõâîðþâàííÿ) òà ñïåöèô³÷íîãî ôóíêö³î-
íàëüíîãî îö³íþâàííÿ ÔÐÌ (îö³íþâàííÿ ôóíêö³îíó-
âàííÿ). Îñòàííº áàçóºòüñÿ íà êîíöåïòóàëüí³é
ñòðóêòóð³ ÌÊÔ òà îòðèìóºòüñÿ çàâäÿêè âèêîðèñ-
òàííþ çàñîá³â ôóíêö³îíàëüíîãî îö³íþâàííÿ òà øêàë.
˳êàð³ ÔÐÌ ìîæóòü çàñòîñîâóâàòè øèðîêèé
ñïåêòð âòðó÷àíü, ïî÷èíàþ÷è â³ä ë³ê³â, âïðàâ, ìà-
íóàëüíî¿ òåðàﳿ, ô³çè÷íèõ ìîäàëüíîñòåé, òåõí³÷íèõ
äîïîì³æíèõ çàñîá³â, îñâ³òí³õ ïðîãðàì òà àäàïòàö³¿
ñåðåäîâèùà. Ñòàíäàðòèçîâàí³ ïðîãðàìè ÔÐÌ ðîç-
ðîáëåí³ äëÿ áàãàòüîõ ñòàí³â çäîðîâ’ÿ òà ïðîáëåì
ôóíêö³îíóâàííÿ, òà ´ðóíòóþòüñÿ íà íàóêîâèõ äî-
êàçàõ òà íàéêðàùèõ ìîäåëÿõ ïðàêòèêè.
²íòåðâåíö³¿ ÔÐÌ òà ïðîãðàìè çàâæäè º ïàö³ºíò-
ñïðÿìîâàíèìè, à ðåçóëüòàòè âêëþ÷àþòü ôóíêö³î-
íàëüí³ òà ïåðñîíàëüí³ âèì³ðè (çìåíøåííÿ
ïîðóøåíü, îáìåæåíü àêòèâíîñò³ òà îáìåæåíü ìîæ-
¹2(2) *2018

ëèâîñò³ ó÷àñò³). Âîíè òàêîæ ñïðÿìîâàí³ íà çíèæåí-
íÿ âèòðàò, à òàêîæ çíèæåííÿ ñìåðòíîñò³ äëÿ ïåâ-
íèõ ãðóï ïàö³ºíò³â. Ïðîãðàìè ÔÐÌ, â á³ëüøîñò³
âèïàäê³â, ðåàë³çóþòüñÿ ìóëüòè-ïðîôåñ³éíèìè
ðåàá³ë³òàö³éíèìè êîìàíäàìè â ñï³âïðàö³ ç ³íøèìè
ñïåö³àëüíîñòÿìè ï³ä êåð³âíèöòâîì ë³êàð³â ÔÐÌ.
Îñê³ëüêè ÷èñëåíí³ äîêóìåíòè òà äîïîâ³ä³ ÂÎÎÇ
òà ÎÎÍ çàêëèêàþòü äî ïîñèëåííÿ ðåàá³ë³òàö³¿, ÿê
êëþ÷îâî¿ ñòðàòå㳿 îõîðîíè çäîðîâ’ÿ ó XXI ñòîë³òò³
â óñüîìó ñâ³ò³, ïîäàëüøå âïðîâàäæåííÿ ÔÐÌ äî
ñèñòåì îõîðîíè çäîðîâ’ÿ ìຠâèð³øàëüíå çíà÷åí-
íÿ. Ó öüîìó êîíòåêñò³ ÔÐÌ ïîâèííà áóòè çàáåç-
ïå÷åíà âïðîäîâæ óñüîãî êîíòèíóóìó äîïîìîãè òà
íà âñ³õ ð³âíÿõ îõîðîíè çäîðîâ’ÿ, ñïðÿìîâàíèõ íà
â³äïîâ³äí³ ôóíêö³îíàëüí³ ïîòðåáè îñ³á, à òàêîæ íà
òèì÷àñîâ³ àñïåêòè ñòàí³â çäîðîâ’ÿ (âðîäæåíà àáî
íàáóòà ³ ãîñòðà, ïðîãðåñóþ÷à àáî äåãåíåðàòèâíà)
Öå âêëþ÷ຠâ ñåáå àñïåêòè àá³ë³òàö³¿, ðåàá³ë³òàö³¿,
à òàêîæ ÔÐÌ â çàêëàäàõ ãîñòðî¿, ï³äãîñòðî¿ òà
äîâãîòðèâàëî¿ äîïîìîãè.
Îñâ³òà òà íàâ÷àííÿ ó ÔÐÌ
Äëÿ äîñÿãíåííÿ ãàðíîãî ï³äõîäó äî ðåàá³ë³òàö³¿,
ÿê òîãî âèìàãàþòü ºâðîïåéñüê³ òîâàðèñòâà, âñ³
ë³êàð³ òà ôàõ³âö³ îõîðîíè çäîðîâ’ÿ ïîâèíí³ îòðèìó-
âàòè àäåêâàòíó äîäèïëîìíó îñâ³òó. Äëÿ îâîëîä³í-
íÿ íåîáõ³äíèì øèðîêèì êîëîì êîìïåòåíòíîñòåé,
ë³êàð³ ÔÐÌ ïîâèíí³ ïðîéòè äîáðå îðãàí³çîâàíó òà
â³äïîâ³äíî ñòðóêòóðîâàíó ï³ñëÿäèïëîìíó ï³äãîòîâ-
êó àäåêâàòíî¿ òðèâàëîñò³. Îêð³ì çäîáóòòÿ ìåäè÷-
íèõ çíàíü, êîìïåòåíòíîñòåé â îáëàñò³ äîïîìîãè
ïàö³ºíòàì, ñïåöèô³÷íèõ ïðîöåäóðíèõ íàâè÷îê òà
ñòàâëåííÿ ùîäî ì³æîñîáèñò³ñíèõ â³äíîñèí òà
ñï³ëêóâàííÿ, ãëèáîêå ðîçóì³ííÿ îñíîâíèõ ïðèíöèï³â
ìåäè÷íî¿ åòèêè òà ãðîìàäñüêîãî çäîðîâ’ÿ,
çäàòí³ñòü çàñòîñîâóâàòè ïðèíöèïè äîïîìîãè òà
ïðîô³ëàêòèêè äëÿ ëþäåé ç îáìåæåííÿìè æèòòº-
ä³ÿëüíîñò³, çäàòí³ñòü äî îïàíóâàííÿ ñòðàòåã³ÿìè
ðå³íòåãðàö³¿ ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³ äî ñóñï³ëüñòâà, çàñòîñîâóâàííÿ ïðèíöèï³â
çàáåçïå÷åííÿ ÿêîñò³ òà ñïðèÿííÿ áåçïåðåðâíîìó
ïðîôåñ³éíîìó ðîçâèòêó, ùî ´ðóíòóºòüñÿ íà ïðàê-
òè÷í³é ä³ÿëüíîñò³. Íà ºâðîïåéñüêîìó ð³âí³ íåîáõ³äí³
ðåêîìåíäàö³¿ òà ñòàíäàðòè íàäàþòüñÿ Ðàäîþ
ÔÐÌ ªÑÌÑ. Íàðåøò³, àëå íå ìåíø âàæëèâèì º
òîé ôàêò, ùî áåçïåðåðâíèé ïðîôåñ³éíèé ðîçâèòîê
òà ïðîãðàìè ìåäè÷íî¿ îñâ³òè íàäàþòüñÿ ªâðî-
ïåéñüêèìè Îðãàíàìè ÔÐÌ (ó ñï³âïðàö³ ç ªâðî-
ïåéñüêîþ Ðàäîþ ç àêðåäèòàö³¿ áåçïåðåðâíî¿ ìå-
äè÷íî¿ îñâ³òè).
Íàóêà òà äîñë³äæåííÿ â ãàëóç³ ÔÐÌ
Ó çâ’ÿçêó ç øèðîêèì ñïåêòðîì çàâäàíü ÔÐÌ,
íàóêà òà äîñë³äæåííÿ ó ÔÐÌ òàêîæ ìàþòü øèðî-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß
êèé ñïåêòð òåì. ³í âàð³þºòüñÿ â³ä ôóíäàìåíòàëü-
íèõ äîñë³äæåíü ìåõàí³çì³â õâîðîá òà îáìåæåíü
æèòòºä³ÿëüíîñò³, ìåõàí³çì³â 䳿 âòðó÷àíü, äîñë³ä-
æåíü êë³í³÷íèõ ðåçóëüòàò³â, åï³äåì³îëîã³÷íèõ äî-
ñë³äæåíü, à òàêîæ íàóêîâèõ ï³äõîä³â äî ðåàë³çàö³¿
ïîñëóã ç ÔÐÌ ó ñèñòåìàõ îõîðîíè çäîðîâ’ÿ òà
ðîçðîáö³ òåîðåòè÷íî¿ ï³äîñíîâè ç ïèòàíü îáìåæåíü
æèòòºä³ÿëüíîñò³ òà ðåàá³ë³òàö³¿. Öå çíàéøëî ñâîº
â³äîáðàæåííÿ â òåìàõ ºâðîïåéñüêèõ òà ì³æíàðîä-
íèõ êîíãðåñ³â òà æóðíàë³â ÔÐÌ. Ïðîòå, íèí³øíÿ
ñèòóàö³ÿ ç íàóêîâî-äîñë³äíîþ ä³ÿëüí³ñòþ ó ÔÐÌ
â ªâðîï³ – öå íîâ³ ìîæëèâîñò³ òà âèêëèêè.
Âèçíà÷åíà âàæëèâ³ñòü äîñë³äæåíü ó ãàëóç³ ðå-
àá³ë³òàö³¿ òà ¿õ ñïåöèô³÷íà ìåòîäîëîã³ÿ âíàñë³äîê
ïðîáëåìè ïîäîëàííÿ ðîçðèâó ì³æ á³îëî㳺þ òà ïî-
âåä³íêîþ òà âèñâ³òëåííÿ òàêèõ òåì, ÿê âçàºìî-
çâ’ÿçîê ì³æ á³îìåäèöèíîþ òà ÔÐÌ òà äîñë³äæåí-
íÿ ðåçóëüòàò³â ÔÐÌ. ÔÐÌ òàêîæ ïîâèííà
ñòèêàòèñÿ ç ïðîáëåìàìè äîêàçîâî¿ ìåäèöèíè, ÿê³
òàêîæ ðîçãëÿäàþòüñÿ â íîâ³é Êîêðàí³âñüê³é ðåàá-
³ë³òàö³éí³é ñôåð³. Íàðåøò³, ïåðåíåñåííÿ íàóêîâèõ
çíàíü ó êë³í³÷íó ïðàêòèêó ìຠâåëèêå çíà÷åííÿ.
Øëÿõ âïåðåä
Âèêëèêè òà ïåðñïåêòèâè ðîçâèòêó ÔÐÌ â
ªâðîï³ âèíèêàþòü âíàñë³äîê äðàìàòè÷íèõ çì³í ó
äåìîãðàô³¿, î÷³êóâàíî¿ òðèâàëîñò³ æèòòÿ, ïîêàç-
íèê³â âèæèâàííÿ, òÿãàðÿ îáìåæåíü æèòòºä³ÿëü-
íîñò³, çá³ëüøåííÿ ïîøèðåíîñò³ äîâãîòðèâàëèõ
ñòàí³â çäîðîâ’ÿ, ïðîãðåñó ó òåõíîëîã³ÿõ, à òàêîæ
ìåäè÷íèõ âèòðàòàõ òà çì³íàõ ñóñï³ëüñòâà ç òî÷êè
çîðó âèìîã äî áëàãîïîëó÷÷ÿ òà ÿêîñò³ æèòòÿ ðà-
çîì ³ç çäîðîâ’ÿì. Âñ³ ö³ âèêëèêè ïîºäíóþòüñÿ ç
îñîáëèâîñòÿìè ÔÐÌ, ÿêà º ìåäè÷íîþ ñïåö³àëü-
í³ñòþ, ùî çîñåðåäæóº óâàãó íà ëþäèí³ â ö³ëîìó òà
éîãî àáî ¿¿ ôóíêö³îíóâàíí³ ïðè ð³çíèõ ñòàíàõ çäî-
ðîâ’ÿ, ç ìåòîþ çàáåçïå÷åííÿ íàéêðàùî¿ ìîæëèâî¿
ó÷àñò³ øëÿõîì ïîêðàùåííÿ àêòèâíîñò³ òà çìåíøåí-
íÿ ïîðóøåíü. Ïðåäñòàâëåí³ ìîæëèâ³ íàñë³äêè öèõ
çì³í ó ìàéáóòí³é åâîëþö³¿ êë³í³÷íî¿ ïðàêòèêè ÔÐÌ,
ïîñëóã, îñâ³òè, äîñë³äæåíü; êð³ì òîãî, ïðåäñòàâëå-
íî áà÷åííÿ ïðîãðåñó ãàðìîí³çàö³¿ ðîçâèòêó ÔÐÌ ó
âñ³é ªâðîï³ òà ìîæëèâèé âíåñîê ÔÐÌ ó ïëàíóâàí-
íÿ ïîë³òèêè.
Ââåäåííÿ
Á³ëà êíèãà (ÁÊ) âèçíà÷ຠïðèðîäó, ñôåðó ðîáî-
òè òà ïàðàìåòðè ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäè-
öèíè (ÔÐÌ) â ªâðîï³. Âîíà îïèñóº ñïåö³àëüí³ñòü
òà êîìïåòåíòíîñò³, ùî î÷³êóþòüñÿ â³ä ïîâí³ñòþ
íàâ÷åíèõ ôàõ³âö³â (ë³êàð ÔÐÌ) ó ãàëóç³, à òàêîæ
êë³í³÷íîãî êîíòåêñòó ðîáîòè òà õàðàêòåðó îñâ³òè
òà íàâ÷àííÿ ñïåö³àë³ñò³â. Êíèãà ïîáóäîâàíà íà
13
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

äâîõ ïîïåðåäí³õ âèäàííÿõ ÁÊ, ÿê³ ç’ÿâèëèñÿ â 19891 ÔÐÌ, ÿêà º ìåäè÷íîþ ñïåö³àëüí³ñòþ, ùî ïðèñâÿ-
òà 2006/2007 ðîêàõ4,5. ÷åíà ðåàá³ë³òàö³¿ ïàö³ºíò³â òà ëþäåé ç îáìåæåííÿ-
ÁÊ ñïðÿìîâàíà ïåðåâàæíî íà ï’ÿòü ãðóï: ìè æèòòºä³ÿëüíîñò³. Âèçíà÷åíî ïîíÿòòÿ ÔÐÌ, ÿê
– ë³êàð³ ÔÐÌ òà ³íø³ ôàõ³âö³ ðåàá³ë³òàö³¿; ïåðâèííî¿ ìåäè÷íî¿ ñïåö³àëüíîñò³ (áàçîâ³ ïîíÿòòÿ)
– ôàõ³âö³ îõîðîíè çäîðîâ’ÿ ³íøèõ ìåäè÷íèõ ñïåö³- ðàçîì ç éîãî ðîçâèòêîì (çâ³äêè âèõîäèòü ÔÐÌ) òà
àëüíîñòåé òà ïðîôåñ³é, ïîâ’ÿçàíèõ ç ìåäèöèíîþ; îðãàí³çàö³ºþ (ä³ÿëüí³ñòü ÔÐÌ òà ¿¿ ïðåäñòàâíèöò-
– ðåçèäåíòè ÔÐÌ, ñòóäåíòè ìåäè÷íèõ òà ³íøèõ âî) ó ªâðîï³. Ïåðåõîäÿ÷è äî ïðàêòèêè, îáãîâîðþ-
ðåàá³ë³òàö³éíèõ ïðîôåñ³é; þòüñÿ îñíîâè ÔÐÌ (çíàííÿ, íàâè÷êè òà âì³ííÿ
– ïîë³òèêè òà îðãàí³çàòîðè ç ïèòàíü îõîðîí³ çäîðî- ë³êàð³â ÔÐÌ), ñôåðà êîìïåòåíòíîñòåé (ÔÐÌ íà
â’ÿ, ðåàá³ë³òàö³¿ òà îáìåæåíü æèòòºä³ÿëüíîñò³; ïðàêòèö³) òà ì³ñöå â ñèñòåìàõ îõîðîíè çäîðîâ’ÿ òà
– øèðîêà ãðîìàäñüê³ñòü òà, çîêðåìà, ëþäè ç îá- ñóñï³ëüñòâ³. Ïåðåä òèì, ÿê çðîáèòè âèñíîâêè ïðî
ìåæåííÿìè æèòòºä³ÿëüíîñò³ òà ïðåäñòàâíèêè ¿õ ïîäàëüø³ øëÿõè âïðîâàäæåííÿ ÔÐÌ â ªâðîï³ (âèê-
îðãàí³çàö³é. ëèêè òà ïåðñïåêòèâè íà ìàéáóòíº) òàêîæ ïîâ³äîì-
ªâðîïåéñüêà ìåäè÷íà ñï³ëüíîòà ïîñò³éíî ðîç- ëÿºòüñÿ ïðî îñâ³òó ç ÔÐÌ â ªâðîï³ (ôîðìóâàííÿ
øèðþºòüñÿ, ³ öå äຠäîäàòêîâ³ ìîæëèâîñò³ òà âèê- ìàéáóòíüîãî) òà ïðî íàóêîâ³ äîñë³äæåííÿ ó ñôåð³
ëèêè, îñîáëèâî ç³ ñõ³äíî¿ ÷àñòèíè êîíòèíåíòó, ùîá ÔÐÌ (âèêëèêè òà îñîáëèâîñò³).
ä³çíàòèñü, ùî ðîáèòü ºâðîïåéñüêà ñï³ëüíîòà ÔÐÌ,
øëÿõîì ðîçðîáêè êîíêðåòíèõ ïðîåêò³â ç Ñåêö³ºþ
ÔÐÌ ªâðîïåéñüêîãî Ñîþçó ìåäè÷íèõ ñïåö³àë³ñò³â Ìåòîäîëîã³ÿ òðåòüîãî âèäàííÿ
(ªÑÌÑ) òà ªâðîïåéñüêèì Òîâàðèñòâîì ÔÐÌ ÁÊ ç ÔÐÌ ó ªâðîï³
(ªÒÔÐÌ). Öÿ ïóáë³êàö³ÿ ñïðÿìîâàíà íà ñïðèÿííÿ
ïðîöåñó ãàðìîí³çàö³¿ ä³ÿëüíîñò³ ñïåö³àë³ñò³â ÔÐÌ
Òðåòº âèäàííÿ Á³ëî¿ êíèãè (ÁÊ) ç Ô³çè÷íî¿ òà
äëÿ äîïîìîãè ëþäÿì, ùî çàçíàþòü îáìåæåíü æèò-
Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ áóëî
òºä³ÿëüíîñò³, ãàðíèìè ïîñëóãàìè â³ä ñïåö³àëüíîñò³
ñòâîðåíî â³äïîâ³äíî äî êîíêðåòíî¿ ìåòîäîëî㳿 äëÿ
íåçàëåæíî â³ä òîãî, äå âîíè æèâóòü ó ö³é ðîçøè-
äîñÿãíåííÿ íàéá³ëüø ïîñë³äîâíîãî ³ ñïðàâæíüîãî
ðþþ÷èéñÿ ñï³ëüíîò³. ÁÊ ïðîïîíóºòüñÿ ñï³ëüíîò³
ïîäàííÿ òåêñòó. Âîíî áóëî ï³äãîòîâëåíî òà
ÔÐÌ ó âñüîìó ñâ³ò³, ÿê äîâ³äíèê, íàâ³òü â óìîâàõ
çàòâåðäæåíî óñ³ìà äåëåãàòàìè òà àêàäåì³êàìè
ð³çíî¿ ñèòóàö³¿ òà âèêëèê³â.
Àëüÿíñó ªâðîïåéñüêèõ Îðãàí³â ÔÐÌ. Âñ³ äåëåãà-
Îõîðîíà çäîðîâ’ÿ çàçíຠâåëèêèõ çì³í ÿê íà
òè, ÿê³ áóëè îô³ö³éíî ïðèçíà÷åí³ íàö³îíàëüíèìè
ºâðîïåéñüêîìó, òàê ³ íà íàö³îíàëüíîìó ð³âíÿõ.
êîìïåòåíòíèìè îðãàíàìè àáî íàö³îíàëüíèìè òîâà-
Øèðîêà ãðîìàäñüê³ñòü ìຠçðîñòàþ÷³ î÷³êóâàííÿ
ðèñòâàìè, ïðîâîäèëè êîíñóëüòàö³¿ ç ¿õ ÷ëåíàìè
ùîäî ìåäè÷íî¿ äîïîìîãè, ÿêà â³ääçåðêàëþº ô³ëî-
âïðîäîâæ ïðîöåñó ñòâîðåííÿ ÁÊ. Îòæå, ÁÊ ïðåä-
ñîôñüê³ äèñêóñ³¿ ùîäî ïðàâ òà îáîâ’ÿçê³â ëþäèíè
ñòàâëÿº ïîãëÿäè âñ³º¿ ºâðîïåéñüêî¿ ñï³ëüíîòè ÔÐÌ.
â ñóñï³ëüñòâ³, çîêðåìà ïîâíî¿ ó÷àñò³ ëþäåé ç îá-
¯¿ ôîðìóâàííÿ áóëî ïî-ñïðàâæíüîìó êîëåêòèâíîþ
ìåæåííÿìè æèòòºä³ÿëüíîñò³. Ìåäè÷íà ïðàêòèêà
ñïðîáîþ ³ç çàëó÷åííÿì ÷îòèðüîõ ªâðîïåéñüêèõ
ïîñò³éíî åâîëþö³îíóº ç óäîñêîíàëåííÿì êë³í³÷íèõ
Îðãàí³â ÔÐÌ, 11 ðåäàêòîð³â, 38 ïåðøèõ àâòîð³â, 63
ñòàíäàðò³â òà íåîáõ³äí³ñòþ äîñêîíàëîñò³ øëÿõîì
ñï³âàâòîð³â, 38 âíóòð³øí³õ òà 39 çîâí³øí³õ ðåöåí-
áåçïåðåðâíîãî ïðîôåñ³éíîãî ðîçâèòêó, ïîâòîðíî¿
çåíò³â, 241 äåëåãàò³â òà àêàäåì³ê³â, ùî ïðåäñòàâ-
îö³íêè òà ï³äâèùåííÿ êâàë³ô³êàö³¿ ñïåö³àë³ñò³â.
ëÿëè 36 òîâàðèñòâ ÔÐÌ íà êîíòèíåíò³.
Îñê³ëüêè ïîòðåáà â á³ëüøèõ êîìïåòåíòíîñòÿõ çðî-
Ïðîòÿãîì 2014 ðîêó ³äåÿ íîâîãî âèäàííÿ ÁÊ
ñòàº, äëÿ ÔÐÌ º âàæëèâèì ïåðåîñìèñëåííÿ òîãî,
áóëà çàïðîïîíîâàíà âñåðåäèí³ ªâðîïåéñüêî¿ Àêà-
ùî âîíà º, ùî âîíà ìîæå çàïðîïîíóâàòè, ÿê âîíà
äå쳿 Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÅÀÐÌ), òà áóëî
ìîæå íàéêðàùå çàáåçïå÷óâàòè ñâî¿ ïîñëóãè òà
ðîçïî÷àòî îáãîâîðåííÿ âñåðåäèí³ ³íøèõ ªâðî-
ñïåö³àëüí³ çíàííÿ, à òàêîæ ÿê³ ñòàíäàðòè íàâ÷àí-
ïåéñüêèõ Îðãàí³â ÔÐÌ: ªâðîïåéñüêîãî Òîâàðè-
íÿ ïîâèíí³ âèìàãàòèñÿ â³ä âñòóïíèê³â äî ñïåö³àëü-
ñòâà ÔÐÌ (ªÒÔÐÌ) òà Ñåêö³¿ òà Ðàäè ÔÐÌ ªâðî-
íîñò³. Ìåòà ö³º¿ êíèãè â³äïîâ³ñòè íà ö³ âèìîãè.
ïåéñüêîãî ñîþçó ìåäè÷íèõ ôàõ³âö³â (ªÑÌÑ).
Òåêñò ïðåäñòàâëåíèé ó ÷îòèðüîõ ÷àñòèíàõ (îñ-
³äïîâ³äíî äî ìåòîä³â ðîáîòè Îðãàí³â, áóëè çàï-
íîâè ÔÐÌ, ¿¿ îðãàí³çàö³¿ òà ïðàêòèêà â ªâðîï³ òà
ðîïîíîâàí³ ïðîïîçèö³¿, ÿê³ âñ³ áóëè îäíîñòàéíî
âèñíîâêè) ç äîäàòêàìè (âêëþ÷àþ÷è ðîçä³ë ìå-
ñõâàëåí³ ïðîòÿãîì âñüîãî ïðîöåñó.
òîä³â). Çì³ñò ïî÷èíàºòüñÿ ç îñíîâíèõ âèçíà÷åíü
Ñåðåä ïåðøèõ ð³øåíü áóëî ñòâîðåííÿ Êåð³âíî-
(êîíöåïö³ÿ òà ñïåö³àëüí³ñòü) ïåðåä ðîçãëÿäîì àê-
ãî êîì³òåòó, âêëþ÷àþ÷è 2 ÷ëåí³â ç êîæíîãî ªâðî-
òóàëüíîñò³ ðåàá³ë³òàö³¿ äëÿ ëþäåé ç îáìåæåííÿìè
ïåéñüêîãî Îðãàíó. Êåð³âíèé êîì³òåò âêëþ÷àâ:
æèòòºä³ÿëüíîñò³ òà ñóñï³ëüñòâîì (òîáòî, ÷îìó öå
– Stefano Negrini (Ñåêö³ÿ ÔÐÌ ªÑÌÑ) – êîîðäè-
íåîáõ³äíî). Òåêñò ïîò³ì ïåðåõîäèòü â³ä çàãàëüíî¿
íàòîð,
ðåàá³ë³òàö³¿, ùî íå º ñïåöèô³÷íî ìåäè÷íîþ, äî

14 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018

– Sasa Moslavac (Ðàäà ÔÐÌ ªÑÌÑ) – ñåêðåòàð,
– Pedro Cantista (ªÒÔÐÌ),
– Gordana Devecerski (ªÒÔÐÌ),
– Alvydas Juocevicius (Ðàäà ÔÐÌ ªÑÌÑ),
– Christoph Gutenbrunner (ªÀÐÌ),
– Enrique Varela Donoso (Ñåêö³ÿ ÔÐÌ ªÑÌÑ);
– Anthony B Ward (ªÀÐÌ).
Êåð³âíèé êîì³òåò ðåãóëÿðíî çóñòð³÷àâñÿ ³ ïðî-
ïîíóâàâ îñíîâí³ ïðîïîçèö³¿ íà ñõâàëåííÿ. Íà âñ³õ
åòàïàõ áóëè çàä³ÿí³ Ïðåçèäåíòè òà Ñåêðåòàð³ Òî-
âàðèñòâ. Òî áóëè:
– ªÀÐÌ: Guy Vanderstraeten ³ Xanthi Michail
(Ïðåçèäåíòè), à òàêîæ Angela McNamara (Ñåê-
ðåòàð),
– ªÒÔÐÌ: Xanthi Michail òà Alain Delarque (Ïðå-
çèäåíòè), Elena Ilieva òà Carlotte Kiekens (Ñåê-
ðåòàð³),
– Ñåêö³ÿ ÔÐÌ ªÑÌÑ: Nicolas Christodoulou (Ïðå-
çèäåíò), Mauro Zampolini (Ñåêðåòàð),
– Ðàäà ÔÐÌ ªÑÌÑ (äëÿ Êîëåäæó): Alvydas
Juocevicius òà Maria Gabriella Ceravolo (Ïðåçè-
äåíòè), Nikolaos Barotsis (Ñåêðåòàð).
Ó ïåðøîìó ï³âð³÷÷³ 2015 ðîêó, íàðåøò³, áóëî
âèçíà÷åíî íåîáõ³äí³ñòü íîâîãî âèäàííÿ (òðåòüîãî)
ÁÊ ÷åðåç áàãàòî çì³í ó ºâðîïåéñüêèõ ñóñï³ëüñòâàõ,
à îòæå, ³ â ïðàêòèö³ ÔÐÌ, ùî ìàëî â³äîáðàæåííÿ
â äîêóìåíòàõ ªâðîïè òà ñâ³òó. Àâòîðàìè ÁÊ ñòà-
ëè ÷îòèðè ªâðîïåéñüê³ Îðãàíè ÔÐÌ, ÿê³ òàêîæ º
âëàñíèêàìè àâòîðñüêèõ ïðàâ:
– ªâðîïåéñüêà Àêàäåì³ÿ Ðåàá³ë³òàö³éíî¿ Ìåäèöè-
íè (ªÀÐÌ),
– ªâðîïåéñüêå Òîâàðèñòâî ÔÐÌ (ªÒÔÐÌ),
– Ñåêö³ÿ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó ìåäè÷íèõ
ñïåö³àë³ñò³â (Ñåêö³ÿ ÔÐÌ ªÑÌÑ),
– ªâðîïåéñüêèé Êîëåäæ ÔÐÌ (â îñîá³ Ðàäè
ÔÐÌ ªÑÌÑ).
Çàö³êàâëåíèìè ñòîðîíàìè º Íàö³îíàëüí³ Òîâà-
ðèñòâà ÔÐÌ.
ÁÊ ïðîäîâæóº ôîðìàò ïîïåðåäí³õ âèäàíü:
– Ïåðøå âèäàííÿ (1989 ð.): Êíèãà, îïóáë³êîâàíà
Universidad Complutense de Madrid íà ÷îòèðüîõ
ìîâàõ: àíãë³éñüêà, ôðàíöóçüêà, ³òàë³éñüêà, ³ñïàí-
ñüêà. Àâòîð: ªÀÐÌ ç Ñåêö³ºþ ÔÐÌ ªÑÌÑ òà
ªâðîïåéñüêîþ Ôåäåðàö³ºþ Ô³çè÷íî¿ Ìåäèöèíè
òà Ðåàá³ë³òàö³¿;
– Äðóãå âèäàííÿ (2006-2007): îïóáë³êîâàíî â ñïå-
ö³àëüíèõ âèäàííÿõ 2 æóðíàë³â (â PubMed),
Europa Medicophysica (íèí³ European Journal of
Physical and Rehabilitation Medicine); Journal of
Rehabilitation Medicine. Ìîâà: àíãë³éñüêà, ïîò³ì
áóëà ïåðåêëàäåíà ð³çíèìè ºâðîïåéñüêèìè ìî-
âàìè íàö³îíàëüíèìè òîâàðèñòâàìè. Àâòîðè:
ªÀÐÌ òà Ñåêö³ÿ òà Ðàäà ÔÐÌ ªÑÌÑ ó
ñï³âïðàö³ ³ç ªÒÔÐÌ.
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß
Ìåòà ÁÊ ïîëÿãຠâ îïèñ³, ç ºâðîïåéñüêî¿ òî÷êè
çîðó, ðîáîòè ñïåö³àëüíîñò³ ÔÐÌ òà ë³êàð³â ÔÐÌ ó:
– ì³íëèâîìó ñâ³ò³ ñèñòåì îõîðîíè çäîðîâ’ÿ òà
ñêîðî÷åííÿ ðåñóðñ³â;
– ðåàãóâàíí³ òà âíåñêó äî ìåäè÷íîãî ïðîãðåñó òà
òåõíîëîã³÷íèõ ³ííîâàö³é;
– ðîçðîáö³ ñòðàòåã³é âèð³øåííÿ çàâäàíü íàóêîâî-
òåõí³÷íîãî ïðîãðåñó;
– ðîáîò³ ç ì³íëèâèìè ïåðñïåêòèâàìè îáìåæåíü
æèòòºä³ÿëüíîñò³;
– ñïðèÿíí³ òà ïîëåãøåíí³ ñàìîñò³éíîñò³ òà ó÷àñò³
ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ â ïî-
âñÿêäåííîìó æèòò³;
– òîìó, ùîá áóòè äèäàêòè÷íèì äîâ³äíèêîì äëÿ
ïðàêòèêè ÔÐÌ òà àêàäåì³÷íîãî æèòòÿ ìîëîäèõ
ïðîôåñ³îíàë³â îõîðîíè çäîðîâ’ÿ (îñîáëèâî
ë³êàð³â ïðîòÿãîì íàâ÷àííÿ).
Áóëî âèð³øåíî ïî÷àòè ç³ çì³ñòó äðóãîãî âèäàí-
íÿ ³ ïðèéíÿòè âñå, ùî áóëî íàïèñàíî, ÿêùî ùå çà-
ñòîñîâóºòüñÿ òà, çà íåîáõ³äíîñò³ çì³íþâàòè òåêñò.
Öå ñïðàâåäëèâî äëÿ:
– ðîçä³ë³â (áóëè âêëþ÷åí³ äåÿê³ íîâ³ ðîçä³ëè –
çîêðåìà, ðîçä³ëè 3 òà 6), ³íîä³ ðîçøèðþþ÷è ïî-
ïåðåäí³ ï³äðîçä³ëè;
– îêðåì³ ï³äðîçä³ëè âñåðåäèí³ ðîçä³ë³â.
Ó äðóãîìó ï³âð³÷÷³ 2015 ð. áóëî çàòâåðäæåíî
Ïîïåðåäí³é çì³ñò, ÿêèé âêëþ÷àâ:
– 11 ðîçä³ë³â ç ðåäàêòîðîì äëÿ êîæíîãî ðîçä³ëó
– áóëî âèð³øåíî îïóáë³êóâàòè êîæíèé ðîçä³ë, ÿê
ñàìîñò³éíèé äîêóìåíò â PubMed, ùîá êðàùå
âèñòàâèòè çì³ñò äëÿ íàóêîâî¿ àóäèòî𳿠ñâ³òó;
îòæå, êîæíèé ðîçä³ë ìຠâëàñíå ðåçþìå ³ âêëþ-
÷ຠêîëåêòèâí³ ³ìåíà àâòîð³â. Ó çàêëþ÷í³é âåðñ³¿
ðîçä³ëàìè º:
– Âèçíà÷åííÿ òà ïîíÿòòÿ ÔÐÌ
– ×îìó ðåàá³ë³òàö³ÿ ïîòð³áíà ³íäèâ³äóóìó òà ñóñ-
ï³ëüñòâó?
– Ïåðâèííà ìåäè÷íà ñïåö³àëüí³ñòü: îñíîâè ÔÐÌ
– ²ñòîð³ÿ ñïåö³àëüíîñò³: çâ³äêè ïîõîäèòü ÔÐÌ
– Îðãàí³çàö³¿ ÔÐÌ â ªâðîï³: ñòðóêòóðà òà
ä³ÿëüí³ñòü
– Çíàííÿ òà íàâè÷êè ë³êàð³â ÔÐÌ
– Ñôåðà êë³í³÷íèõ êîìïåòåíòíîñòåé: ÔÐÌ íà
ïðàêòèö³
– Ñïåö³àëüí³ñòü ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ
òà ñóñï³ëüñòâ³
– Îñâ³òà ³ áåçïåðåðâíèé ïðîôåñ³éíèé ðîçâèòîê:
ôîðìóâàííÿ ìàéáóòíüîãî ÔÐÌ
– Íàóêà òà äîñë³äæåííÿ ó ÔÐÌ: îñîáëèâîñò³ òà
ïðîáëåìè
– Âèêëèêè òà ïåðñïåêòèâè ìàéáóòíüîãî ÔÐÌ
– 62 ï³äðîçä³ëè – êîæíèé ï³äðîçä³ë ìຠê³ëüêà
êëþ÷îâèõ îñ³á ç ñïåöèô³÷íèìè ðîëÿìè:
– Ïåðøèé àâòîð: íàïèñàííÿ ï³äðîçä³ëó: ÷åðíåòêà
(ïî÷èíàþ÷è ç òåêñòó ïîïåðåäíüîãî äðóãîãî âè-
15
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
äàííÿ ÁÊ) òà îñòàòî÷íà âåðñ³ÿ; êîîðäèíàö³ÿ ç³
ñï³âàâòîðàìè; ñë³äêóâàííÿ çà òåðì³íàìè
– ñï³âàâòîðè: âèïðàâëåííÿ òà âäîñêîíàëåííÿ ïåð-
øî¿ ÷åðíåòêè; âîíè ïîõîäÿòü â³ä íàáîðó àâòîð³â
òà/àáî º íîì³íîâàí³ ïåðøèìè àâòîðàìè; â êîæ-
íîìó ï³äðîçä³ë³ âîíè íàäõîäÿòü ç ð³çíèõ îáëàñ-
òåé ªâðîïè (ï³âí³÷, ï³âäåíü, çàõ³ä ³ ñõ³ä)
– Âíóòð³øí³ ðåöåíçåíòè: â³ä ªâðîïåéñüêèõ
Îðãàí³â ÔÐÌ – ïåðøèé îãëÿä ï³äðîçä³ë³â
– Çîâí³øí³ ðåöåíçåíòè: åêñïåðòè ÔÐÌ ïîçà ìåæà-
ìè ªâðîïåéñüêèõ Îðãàí³â ÔÐÌ – ïåðøèé îãëÿä
ï³äðîçä³ë³â
Ïåðø³ àâòîðè êîæíîãî îêðåìîãî ï³äðîçä³ëó îáè-
ðàëèñÿ Êåð³âíèì Êîì³òåòîì â³äïîâ³äíî äî ñïåö³-
àëüíèõ êðèòåð³¿â ï³ñëÿ çàêëèêó äî âñ³õ äåëåãàò³â òà
àêàäåì³ê³â. Êðèòå𳿠âêëþ÷àëè: ñïåöèô³÷íèé
äîñâ³ä, ê³ëüê³ñòü ïóáë³êàö³é â æóðíàëàõ, ³íäåêñî-
âàíèõ PubMed, ³íøèõ ñïåöèô³÷íèõ ïóáë³êàö³é, ïðèé-
íÿòòÿ äëÿ âèêîíàííÿ çàâäàíü òà òåðì³í³â.
Ðåäàêòîðè ÁÊ áóëè îáðàí³ Êåð³âíèì Êîì³òåòîì
ïåðåâàæíî ñåðåä ñâî¿õ ÷ëåí³â, àëå òàêîæ ³ â ªâðî-
ïåéñüêèõ Îðãàíàõ â³äïîâ³äíî äî ¿õíüîãî ñïåöèô³÷-
íîãî äîñâ³äó ðåäàãóâàííÿ â³äïîâ³äíî äî ðîçä³ëó.
Stefano Negrini áóâ êîîðäèíàòîðîì, à Sasa
Moslavac – ñåêðåòàðåì ðåäàêòîð³â. Ðåäàêòîðàìè
îêðåìèõ ðîçä³ë³â º:
– Ðîçä³ë 1: Pedro Cantista, Nicolas Christodoulou
– Ðîçä³ë 2: Anthony B Ward
– Ðîçä³ë 3: Stefano Negrini
– Ðîçä³ë 4: Enrique Varela Donoso
– Ðîçä³ë 5: Mauro Zampolini
Òàáëèöÿ ². Ïðîöåñ îãëÿäó òà ïåðåãëÿäó äî êîíñåíñóñíî¿ êîíôåðåíö³¿ â Ìþíõåí³ (9 áåðåçíÿ 2017 ðîêó)
ɉɟɪɲɚ ɤɨɧɫɟɧɫɭɫɧɚ ɤɨɧɮɟɪɟɧɰɿɹ
(Ʉɨɦɿɬɟɬ ɩɪɨɮɟɫɿɣɧɨʀ ɩɪɚɤɬɢɤɢ ɋɟɤɰɿʀ
ɎɊɆ ȯɋɆɋ)
ɉɟɪɲɢɣ ɨɝɥɹɞ / ɩɟɪɟɝɥɹɞ
Ⱦɪɭɝɢɣ ɨɝɥɹɞ / ɩɟɪɟɝɥɹɞ
Ⱦɪɭɝɚ ɤɨɧɫɟɧɫɭɫɧɚ ɤɨɧɮɟɪɟɧɰɿɹ
(ɪɟɞɚɤɬɨɪɢ)
Ɍɪɟɬɿɣ ɨɝɥɹɞ / ɩɟɪɟɝɥɹɞ
Ɍɪɟɬɹ ɤɨɧɫɟɧɫɭɫɧɚ ɤɨɧɮɟɪɟɧɰɿɹ
(ȯɜɪɨɩɟɣɫɶɤɿ Ɉɪɝɚɧɢ ɎɊɆ)
16 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
– Ðîçä³ë 6: Stefano Negrini
– Ðîçä³ë 7: Christoph Gutenbrunner
– Ðîçä³ë 8: Carlotte Kiekens
– Ðîçä³ë 9: Maria Gabriella Ceravolo
– Ðîçä³ë 10: Alain Delarque
– Ðîçä³ë 11: Stefano Negrini
Ïðîöåñ íàïèñàííÿ áóâ îðãàí³çîâàíèé íàñòóïíè-
ìè êðîêàìè:
– 31 ãðóäíÿ 2015 ð. – Òåðì³í ïåðøîãî çàêëèêó äî
àâòîð³â äëÿ âñ³õ äåëåãàò³â òà àêàäåì³ê³â;
– 28 ëþòîãî 2016 ð. – Òåðì³í ïîäàííÿ äðóãîãî
çàêëèêó äî àâòîð³â äëÿ âñ³õ äåëåãàò³â òà àêà-
äåì³ê³â;
– 15 ëèïíÿ 2016 ð. – Òåðì³í íàïèñàííÿ “÷óòëèâèõ”
ï³äðîçä³ë³â:
– 3.2 åòè÷í³ àñïåêòè;
– 4.5 êîìàíäà ÔÐÌ;
– 5.1 íàïðÿìêè ðîçâèòêó ñôåðè êîìïåòåíò-
íîñòåé ó ÔÐÌ;
– 8.9. Çâ’ÿçîê ç ³íøèìè ñïåö³àëüíîñòÿìè;
– 8.10. Çâ’ÿçîê ç ³íøèìè ôàõ³âöÿìè ðåàá³ë³òàö³¿
– 15 ñåðïíÿ 2016 ð. – Òåðì³í äëÿ âñ³õ ³íøèõ
ï³äðîçä³ë³â
Ïðîöåñ ðîçãëÿäó òà ïåðåãëÿäó áóâ äîñèòü
ñêëàäíèì ³ ïîâí³ñòþ îïèñàíèé ó òàáëèöÿõ ² òà ²².
³í âêëþ÷àâ:
– ÷îòèðè êîíñåíñóñíèõ êîíôåðåíö³¿;
– ÷îòèðè öèêëè îãëÿäó / ïåðåãëÿäó, â ÿêèõ áðàëè
ó÷àñòü óñ³ äåëåãàòè / àêàäåì³êè (1-é òà 3-é) àáî
âñ³ ðåäàêòîðè òà ïðåçèäåíòè (2-é òà 4-é).
Ɉɝɥɹɞ ɉɟɪɟɝɥɹɞ
25.08.2016
ɉɪɚɝɚ (ɑɟɯɿɹ)
ɉɨ "ɱɭɬɥɢɜɢɯ" ɩɿɞɪɨɡɞɿɥɚɯ
30.09.2016 30.11.2016
ȼɧɭɬɪɿɲɧɿ ɬɚ ɡɨɜɧɿɲɧɿ ɪɟɰɟɧɡɟɧɬɢ ɡɚ Ɋɟɞɚɤɬɨɪɢ ɡɚ ʀɯ ɪɨɡɞɿɥɚɦɢ
ɨɤɪɟɦɢɦɢ ɩɿɞɪɨɡɞɿɥɚɦɢ
Ⱦɟɥɟɝɚɬɢ, ɚɤɚɞɟɦɿɤɢ ɬɚ ɪɟɞɚɤɬɨɪɢ ɡɚ
ɨɤɪɟɦɢɦɢ ɩɿɞɪɨɡɞɿɥɚɦɢ
15.12.2016 07.01.2017
Ɋɟɞɚɤɬɨɪɢ ɜɫɿɽʀ ȻɄ Ɋɟɞɚɤɬɨɪɢ ɡɚ ʀɯ ɪɨɡɞɿɥɚɦɢ
16 -17.12.2016
Ɏɨɧɞ Don Gnocchi, Ɋɨɜɚɬɨ (Ȼɪɟɲɢɹ) – ȱɬɚɥɿɹ
Ɂɚ ɤɨɠɧɢɦ ɨɤɪɟɦɢɦ ɪɨɡɞɿɥɨɦ
21.01.2017 31.01.2017
Ɋɟɞɚɤɬɨɪɢ ɜɫɿɽʀ ȻɄ Ɋɟɞɚɤɬɨɪɢ ɡɚ ʀɯ ɪɨɡɞɿɥɚɦɢ
09.03.2017
Ɇɸɧɯɟɧ (ɇɿɦɟɱɱɢɧɚ)
Ⱦɟɥɟɝɚɬɢ ɬɚ ɚɤɚɞɟɦɿɤɢ ɩɨ ɭɫɿɣ ȻɄ
¹2(2) *2018

Òàáëèöÿ ²². Ïðîöåñ îãëÿäó òà ïåðåãëÿäó ï³ñëÿ êîíñåíñóñíî¿ êîíôåðåíö³¿ â Ìþíõåí³
 ö³ëîìó êîæåí ðàóíä îãëÿäó òà ïåðåãëÿäó áóâ
ñïðÿìîâàíèé íà ïîë³ïøåííÿ òà ïîêðàùåííÿ òåêñòó,
ùîá çðîáèòè éîãî óçãîäæåíèì ì³æ ðîçä³ëàìè òà
ï³äðîçä³ëàìè. Ïåðåãëÿä çàâæäè âèêîíóâàëîñÿ ðå-
äàêòîðàìè ïåðñîíàëüíî òà / àáî êîëåêòèâíî, ùîá
çàáåçïå÷èòè îäíîìàí³òí³ñòü òåêñòó.
Ïåðøèé åòàï îãëÿäó çàâåðøèâñÿ íàéâàæëèâ³-
øîþ êîíôåðåíö³ºþ ç êîíñåíñóñó (3-ÿ), ÿêà ïðîõî-
äèëà 9ãî áåðåçíÿ 2017 ðîêó â Ìþíõåí³. Ó÷àñíè-
êàìè áóëè âñ³ äåëåãàòè â³ä ªÒÔÐÌ òà Ñåêö³¿ òà
Ðàäè ÔÐÌ ªÑÌÑ òà âñ³ àêàäåì³êè ªÀÐÌ. Êîæåí
ðåäàêòîð ñâ ãëàâè ïðåäñòàâèâ: çì³ñò ãëàâè, îò-
ðèìàí³ êîìåíòàð³, â³äïîâ³ä³ íà êîìåíòàð³, çì³íè
òåêñòó â³äïîâ³äíî äî êîìåíòàð³â. Äàë³ áóëà ïðî-
âåäåíà äóæå êîðîòêà äèñêóñ³ÿ â³äïîâ³äíî äî íà-
ñòóïíèõ ïðàâèë: óñ³ äåëåãàòè òà àêàäåì³êè ïîâèíí³
áóëè íàäñèëàòè ñâî¿ êîìåíòàð³ (5-é îãëÿä) äî 28
ëþòîãî. Îñê³ëüêè çàãàëüíå îáãîâîðåííÿ áóëî íå-
ìîæëèâèì ÷åðåç ÷àñîâ³ îáìåæåííÿ, äåÿê³ êîìåí-
òàð³ áóëè äîçâîëåí³, à ïîò³ì âñ³ì ó÷àñíèêàì äîâå-
ëîñÿ íàäñèëàòè ñâî¿ îñòàíí³ êîìåíòàð³, ÿê ïîêàçàíî
ó òàáëèö³ ²².
Ïóáë³êàö³ÿ ÁÊ áóëà çàïëàíîâàíà íà ñ³÷åíü 2018
ðîêó. Íàâåñí³ 2017 ðîêó áóëî âèð³øåíî ñïî÷àòêó
çâåðíóòèñÿ äî æóðíàë³â, ÿê³ îïóáë³êóâàëè ïîïå-
ðåäíº äðóãå âèäàííÿ (European Journal of PRM òà
Journal of Rehabilitation Medicine). ßêùî âîíè ïðèé-
ìóòü ïðàâèëà, âîíè áóäóòü äâîìà æóðíàëàìè, ùî
ïóáë³êóþòü ÁÊ. Ïðàâèëà âêëþ÷àþòü â ñåáå:
– Àâòîðñüêå ïðàâî çàëèøàºòüñÿ ó îðãàíàõ Àëü-
ÿíñó ªâðîïåéñüêèõ Îðãàí³â ÔÐÌ;
– ³äêðèòèé îí-ëàéí äîñòóï;
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß
– Áåçêîøòîâíà âåðñ³ÿ äëÿ äðóêó, âêëþ÷àþ÷è
ò³ëüêè Á³ëó Êíèãó;
– Ïóáë³êàö³ÿ â ñ³÷í³ 2018 ð;
– Äîñòóï äî PubMed äëÿ âñ³º¿ ÁÊ, âêëþ÷àþ÷è
ïåðåäìîâó, âñòóï, êîðîòêèé çì³ñò òà ìåòîäî-
ëîã³þ;
– Êîæíà ãëàâà ïóáë³êóºòüñÿ, ÿê îêðåìèé çàïèñ
PubMed ç çàãàëüíèì çàãîëîâêîì: Á³ëà êíèãà
ÔÐÌ â ªâðîï³. “Íàçâà”. “ϳäçàãîëîâîê”;
– Âèçíàííÿ òîãî, ùî äîêóìåíòè áóäóòü íåãàéíî
ïîâ’ÿçàí³ ç âåá-ñàéòîì æóðíàë³â, ³ ùî äî ïóáë³-
êàö³¿ pdf íà âåá-ñàéò³ Àëüÿíñó ªâðîïåéñüêèõ
Îðãàí³â ÔÐÌ áóäå âñòàíîâëåíî 2-ð³÷íå åìáàð-
ãî.
Îô³ö³éíèé çàïóñê â³äáóäåòüñÿ ï³ä ÷àñ Êîíãðå-
ñó ªÒÔÐÌ (ç ªÀÐÌ òà Ñåêö³ºþ òà Ðàäîþ ÔÐÌ
ªÑÌÑ) ó ³ëüíþñ³ ç 1 ïî 6 òðàâíÿ 2018 ðîêó. ÁÊ
áóäå ïðåäñòàâëåíà ï³ä ÷àñ öåðåìîí³¿ â³äêðèòòÿ, à
ð³çí³ ãëàâè áóäóòü ïðåäñòàâëåí³ â ÿêîñò³ ëåêö³é ïðî-
òÿãîì óñüîãî Êîíãðåñó íà â³äïîâ³äíèõ òåìàòè÷íèõ
çàñ³äàííÿõ, ùîá ñòàòè “îñîáëèâèì ïóíêòîì” âñüî-
ãî Êîíãðåñó. Òàêîæ áóëà ïîãîäæåíà ñâ³òîâà ïðå-
çåíòàö³ÿ ç International Society of PRM (ISPRM) ç
8 ïî 12 ëèïíÿ 2018 ðîêó ï³ä ÷àñ Êîíãðåñó ISPRM ó
Ïàðèæ³.
Ïîñèëàííÿ
1. European Academy of Rehabilitation Medicine, European
Union of Medical Specialists, Physical Medicine and
Rehabilitation Section, European Federation of Physical
Medicine and Rehabilitation. White Book of Physical and
17
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Rehabilitation Medicine in Europe. 1st Edition. Madrid:
Universidad Complutense de Madrid; 1989.
2. World Health Organization. International Classification of
Impairments, Disabilities, and Handicaps. 1980. 207 p.
3. World Health Organization. WHO | International Classification
of Functioning, Disability and Health (ICF) [Internet]. WHO.
[cited 2014 Aug 19]. Available from: http://www.who.int/
classifications/icf/en/
4. Section of Physical and Rehabilitation Medicine Union
Européenne des Médecins Spécialistes (UEMS), European
Board of Physical and Rehabilitation Medicine, Académie
Européenne de Médecine de Réadaptation, European Society
for Physical and Rehabilitation Medicine. White book on
physical and rehabilitation medicine in Europe. Eur
Medicophysica. 2006 Dec;42(4):292–332.
5. White book on Physical and Rehabilitation Medicine in Europe.
J Rehabil Med. 2007 Jan;(45 Suppl):6–47.
6. Convention on the rights of persons with disabilities [Internet].
[cited 2014 Nov 8]. Available from: http://www.un.org/
disabilities/convention/conventionfull.shtml
7. Article 26 – Habilitation and rehabilitation | United Nations
Enable [Internet]. [cited 2017 Jul 15]. Available from: https:/
/www.un.org/development/desa/disabilities/convention-on-
the-rights-of-persons-with-disabilities/article-26-habilitation-
and-rehabilitation.html
8. WHO | World report on disability [Internet]. WHO. [cited
2014 Nov 8]. Available from: http://www.who.int/disabilities/
world_report/2011/en/
9. WHO | WHO global disability action plan 2014-2021
[Internet]. WHO. [cited 2014 Oct 21]. Available from: http:/
/www.who.int/disabilities/actionplan/en/
10. World Health Organization. Rehabilitation 2030: a call for
action: Meeting report [Internet]. WHO; 2017. Available from:
http://www.who.int/disabilities/care/rehab-2030/en/

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Stefano Negrini,
Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner,
Carlotte Kiekens, Sasa Moslavac, Enrique Varela-Donoso, Anthony B Ward, Mauro Zampolini.
• Ïðåçèäåíòè ªâðîïåéñüêèõ îðãàí³â ÔÐÌ: Xanthi Michail (Ïðåçèäåíò ªÀÐÌ), Alain Delarque (Ïðåçè-
äåíò ªÒÔÐÌ), Nicolas Christodoulou (Ïðåçèäåíò Ñåêö³¿ ÔÐÌ ªÑÌÑ), Maria Gabriella Ceravolo (Ïðå-
çèäåíò ÅÊÔÐÌ òà Ðàäè ÔÐÌ ªÑÌÑ).
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ

18 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

ÄÎÄÀÒÊÈ

Äîäàòîê 1

Ãëîñàð³é

Ⱥɤɬɢɜɧɿɫɬɶ ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɆɄɎ – ɜɢɤɨɧɚɧɧɹ ɡɚɜɞɚɧɧɹ ɚɛɨ ɞɿʀ ɨɫɨɛɨɸ

Ɉɛɦɟɠɟɧɧɹ ɚɤɬɢɜɧɨɫɬɿ ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɆɄɎ – ɬɪɭɞɧɨɳɿ, ɹɤɿ ɦɨɠɟ ɦɚɬɢ ɥɸɞɢɧɚ ɩɪɢ ɜɢɤɨɧɚɧɧɿ ɚɤɬɢɜɧɨɫɬɿ.
Ƚɨɫɬɪɚ ɮɚɡɚ ȼɿɞɧɨɫɢɬɶɫɹ ɞɨ ɩɟɪɿɨɞɭ ɧɚɞɯɨɞɠɟɧɧɹ ɞɨ ɥɿɤɚɪɧɿ ɧɟɜɿɞɤɥɚɞɧɨʀ ɞɨɩɨɦɨɝɢ ɩɿɫɥɹ ɬɪɚɜɦɢ ɚɛɨ
ɯɜɨɪɨɛɢ, ɚɛɨ ɩɿɫɥɹ ɤɨɦɩɥɟɤɫɧɨɝɨ ɦɟɞɢɱɧɨɝɨ ɥɿɤɭɜɚɧɧɹ ɱɢ ɣɨɝɨ ɭɫɤɥɚɞɧɟɧɶ. ɐɟ ɬɚɤɨɠ ɦɨɠɟ
ɡɚɫɬɨɫɨɜɭɜɚɬɢɫɹ ɞɨ ɝɨɫɬɪɨʀ ɩɨɞɿʀ ɭ ɨɫɨɛɢ ɡ ɿɫɧɭɸɱɢɦ ɨɛɦɟɠɟɧɧɹɦ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ.
Ⱥɞɚɩɬɢɜɧɚ ɮɿɡɢɱɧɚ ȼɢɡɧɚɱɚɽɬɶɫɹ, ɹɤ ɦɿɠ-ɞɢɫɰɢɩɥɿɧɚɪɧɚ ɫɭɤɭɩɧɿɫɬɶ ɡɧɚɧɶ, ɫɩɪɹɦɨɜɚɧɚ ɧɚ ɜɢɹɜɥɟɧɧɹ ɬɚ
ɚɤɬɢɜɧɿɫɬɶ ɜɢɪɿɲɟɧɧɹ ɿɧɞɢɜɿɞɭɚɥɶɧɢɯ ɪɨɡɛɿɠɧɨɫɬɟɣ ɭ ɮɿɡɢɱɧɿɣ ɚɤɬɢɜɧɨɫɬɿ. ɐɟ ɽ ɩɪɨɮɟɫɿɹ, ɳɨ ɧɚɞɚɽ
ɩɨɫɥɭɝɢ ɬɚ ɫɮɟɪɚ ɧɚɭɤɨɜɢɯ ɞɨɫɥɿɞɠɟɧɶ, ɹɤɚ ɩɿɞɬɪɢɦɭɽ ɫɬɚɜɥɟɧɧɹ ɞɨ ɩɪɢɣɧɹɬɬɹ
ɿɧɞɢɜɿɞɭɚɥɶɧɢɯ ɜɿɞɦɿɧɧɨɫɬɟɣ, ɜɢɫɬɭɩɚɽ ɡɚ ɩɨɫɢɥɟɧɧɹ ɞɨɫɬɭɩɭ ɞɨ ɚɤɬɢɜɧɨɝɨ ɫɩɨɫɨɛɭ ɠɢɬɬɹ
ɬɚ ɫɩɨɪɬɭ ɬɚ ɫɩɪɢɹɽ ɿɧɧɨɜɚɰɿɣɧɿɣ ɬɚ ɤɨɨɩɟɪɚɬɢɜɧɿɣ ɫɢɫɬɟɦɚɦ ɧɚɞɚɧɧɹ ɩɨɫɥɭɝ ɬɚ
ɪɨɡɲɢɪɟɧɧɹ ɦɨɠɥɢɜɨɫɬɟɣ. Ⱥɞɚɩɬɢɜɧɚ ɮɿɡɢɱɧɚ ɚɤɬɢɜɧɿɫɬɶ ɜɤɥɸɱɚɽ, ɚɥɟ ɧɟ ɨɛɦɟɠɭɽɬɶɫɹ,
ɮɿɡɢɱɧɟ ɜɢɯɨɜɚɧɧɹ, ɫɩɨɪɬ, ɪɟɤɪɟɚɰɿɸ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɸ.
ɉɪɢɤɥɚɞɧɟ ɞɨɫɥɿɞɠɟɧɧɹ ȼɢɤɨɪɢɫɬɚɧɧɹ ɿɫɧɭɸɱɢɯ ɡɧɚɧɶ, ɫɩɪɹɦɨɜɚɧɟ ɧɚ ɤɨɧɤɪɟɬɧɿ ɰɿɥɿ, ɬɚɤɿ ɹɤ ɪɨɡɪɨɛɤɚ ɧɨɜɨɝɨ
ɥɿɤɚɪɫɶɤɨɝɨ ɡɚɫɨɛɭ, ɧɨɜɨɝɨ ɦɟɞɢɱɧɨɝɨ ɡɚɫɨɛɭ ɚɛɨ ɧɨɜɨɝɨ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨɝɨ ɜɬɪɭɱɚɧɧɹ.
ȼɨɞɧɚ ɬɟɪɚɩɿɹ Ɂɚɝɚɥɶɧɢɣ ɬɟɪɦɿɧ, ɳɨ ɜɿɞɧɨɫɢɬɶɫɹ ɞɨ ɜɫɿɯ ɥɿɤɭɜɚɥɶɧɢɯ ɦɟɬɨɞɿɜ, ɹɤɿ ɦɨɠɧɚ ɜɢɤɨɧɭɜɚɬɢ
ɱɟɪɟɡ ɜɨɞɭ, ɧɟɡɚɥɟɠɧɨ ɜɿɞ ʀɯ ɫɤɥɚɞɭ
Ȼɚɥɶɧɟɨɥɨɝɿɹ Ƚɿɥɤɚ ɦɟɞɢɱɧɨʀ ɧɚɭɤɢ, ɹɤɟ ɡɚɣɦɚɽɬɶɫɹ ɜɢɜɱɟɧɧɹɦ ɬɟɪɚɩɟɜɬɢɱɧɨɝɨ ɜɢɤɨɪɢɫɬɚɧɧɹ ɩɪɢɪɨɞɧɢɯ
ɦɿɧɟɪɚɥɶɧɢɯ ɜɨɞ, ɩɚɪɭ, ɝɚɡɿɜ ɬɚ ɝɪɹɡɿ. ɐɟ ɡɚɫɬɨɫɭɜɚɧɧɹ ɧɚɡɢɜɚɽɬɶɫɹ Ȼɚɥɶɧɟɨɬɟɪɚɩɿɽɸ ɿ
ɜɤɥɸɱɚɽ ɜ ɫɟɛɟ ɧɟ ɬɿɥɶɤɢ ɡɚɫɬɨɫɭɜɚɧɧɹ ɜɚɧɧ, ɚɥɟ ɣ ɿɧɲɢɯ ɦɨɞɚɥɶɧɨɫɬɟɣ, ɬɚɤɢɯ, ɹɤ ɩɢɬɬɹ
ɜɨɞ, ɿɧɝɚɥɹɰɿɹ ɬɚ ɿɧɲɿ ɞɨɩɨɦɿɠɧɿ ɦɟɬɨɞɢ (ɮɿɡɢɱɧɿ ɱɢɧɧɢɤɢ, ɮɚɤɬɨɪɢ ɫɟɪɟɞɨɜɢɳɚ /
ɤɥɿɦɚɬɨɬɟɪɚɩɿɹ), ɦɚɸɱɢ ɜɢɝɥɹɞ ɰɿɥɿɫɧɨɝɨ ɬɚ ɤɨɦɩɥɟɤɫɧɨɝɨ ɬɟɪɚɩɟɜɬɢɱɧɨɝɨ ɩɿɞɯɨɞɭ.
Ȼɚɪ'ɽɪɢ Ɏɚɤɬɨɪɢ ɫɟɪɟɞɨɜɢɳɚ, ɹɤɿ ɡɧɢɠɭɸɬɶ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ / ɡɛɿɥɶɲɭɸɬɶ ɨɛɦɟɠɟɧɧɹ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ.
Ȼɚɡɨɜɿ ɞɨɫɥɿɞɠɟɧɧɹ “Ɂɧɚɧɧɹ ɞɥɹ ɡɧɚɧɧɹ”, ɜɢɜɱɟɧɧɹ ɛɿɨɦɟɞɢɱɧɢɯ ɮɟɧɨɦɟɧɿɜ, ɞɥɹ ɮɨɪɦɭɜɚɧɧɹ ɩɨɜɧɨɝɨ ʀɯ
(ɮɭɧɞɚɦɟɧɬɚɥɶɧɿ ɚɛɨ ɱɢɫɬɿ ɪɨɡɭɦɿɧɧɹ.
ɞɨɫɥɿɞɠɟɧɧɹ)
Ȼɥɨɤɭɜɚɥɶɧɢɤ ɥɿɠɤɚ ɉɚɰɿɽɧɬ, ɹɤɨɝɨ ɛɭɥɨ ɫɯɜɚɥɟɧɨ ɞɨ ɜɢɩɢɫɤɢ ɡ ɫɬɚɰɿɨɧɚɪɭ, ɚɥɟ ɹɤɢɣ ɧɟ ɦɚɽ ɚɥɶɬɟɪɧɚɬɢɜɧɨɝɨ
ɡɚɤɥɚɞɭ, ɞɨ ɹɤɨɝɨ ɜɿɧ/ɜɨɧɚ ɦɨɠɟ ɛɭɬɢ ɩɟɪɟɜɟɞɟɧɚ, ɬɢɦ ɫɚɦɢɦ ɛɥɨɤɭɸɱɢ ɜɢɤɨɪɢɫɬɚɧɧɹ
ɰɶɨɝɨ ɥɿɠɤɚ ɿɧɲɢɦɢ ɩɚɰɿɽɧɬɚɦɢ, ɨɫɨɛɥɢɜɨ ɬɢɦɢ, ɭ ɤɨɝɨ ɛɿɥɶɲ ɝɨɫɬɪɿ ɡɚɯɜɨɪɸɜɚɧɧɹ ɚɛɨ
ɛɿɥɶɲ ɜɢɫɨɤɿ ɩɨɬɪɟɛɢ
Bibliomed ɰɟ ɿɫɩɚɧɫɶɤɚ ɜɿɪɬɭɚɥɶɧɚ ɦɟɞɢɱɧɚ ɛɿɛɥɿɨɬɟɤɚ
Ȼɿɨɦɟɞɢɱɧɿ ɞɨɫɥɿɞɠɟɧɧɹ ȼɤɥɸɱɚɸɬɶ ɞɨɫɥɿɞɠɟɧɧɹ ɛɿɨɥɨɝɿɱɧɨɝɨ ɩɪɨɰɟɫɭ, ɩɪɢɱɢɧ ɡɚɯɜɨɪɸɜɚɧɶ, ʀɯ ɦɟɞɢɱɧɭ
ɞɿɚɝɧɨɫɬɢɤɭ, ɨɰɿɧɤɭ ʀɯ ɧɚɫɥɿɞɤɿɜ ɞɥɹ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ, ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɬɚ
ɡɞɨɪɨɜ'ɹ ɧɚ ɿɧɞɢɜɿɞɭɚɥɶɧɨɦɭ ɬɚ ɫɨɰɿɚɥɶɧɨɦɭ ɪɿɜɧɹɯ. Ȼɿɨɦɟɞɢɱɧɿ ɞɨɫɥɿɞɠɟɧɧɹ ɬɚɤɨɠ
ɨɰɿɧɸɸɬɶ ɜɩɥɢɜɢ ɿɧɬɟɪɜɟɧɰɿɣ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ ɧɚ ɜɫɿɯ ɰɢɯ ɪɿɜɧɹɯ.
Ȼɿɨɩɫɢɯɨɫɨɰɿɚɥɶɧɚ ɦɨɞɟɥɶ ɐɟ ɦɨɞɟɥɶ ɡɞɨɪɨɜ'ɹ, ɪɨɡɪɨɛɥɟɧɚ, ɹɤ ɩɪɨɬɢɥɟɠɧɿɫɬɶ ɲɢɪɨɤɨ ɡɚɫɬɨɫɨɜɭɜɚɧɨʀ ɛɿɨɦɟɞɢɱɧɨʀ.
ȼɨɧɚ ɫɬɜɟɪɞɠɭɽ, ɳɨ ɡɞɨɪɨɜ'ɹ ɬɚ ɯɜɨɪɨɛɚ ɜɢɡɧɚɱɚɸɬɶɫɹ ɞɢɧɚɦɿɱɧɨɸ ɜɡɚɽɦɨɞɿɽɸ ɦɿɠ
ɛɿɨɥɨɝɿɱɧɢɦɢ (ɝɟɧɟɬɢɱɧɢɦɢ, ɛɿɨɯɿɦɿɱɧɢɦɢ ɬɨɳɨ), ɩɫɢɯɨɥɨɝɿɱɧɢɦɢ (ɧɚɫɬɪɿɣ, ɨɫɨɛɢɫɬɿɫɬɶ,
ɩɨɜɟɞɿɧɤɚ ɬɨɳɨ) ɬɚ ɫɨɰɿɚɥɶɧɢɦɢ ɮɚɤɬɨɪɚɦɢ (ɤɭɥɶɬɭɪɧɢɦɢ, ɫɿɦɟɣɧɢɦɢ, ɫɨɰɿɚɥɶɧɨ-
ɟɤɨɧɨɦɿɱɧɢɦɢ, ɦɟɞɢɱɧɢɦɢ ɬɨɳɨ). ȼɨɧɚ ɬɚɤɨɠ ɜɢɫɥɨɜɥɸɽ ɞɭɦɤɭ, ɳɨ ɪɟɡɭɥɶɬɚɬ ɯɜɨɪɨɛɢ
ɩɨɜ'ɹɡɚɧɢɣ ɡ ɰɿɽɸ ɫɤɥɚɞɧɨɸ ɜɡɚɽɦɨɞɿɽɸ.
Ɏɭɧɤɰɿʀ ɨɪɝɚɧɿɡɦɭ ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɆɄɎ – ɮɿɡɿɨɥɨɝɿɱɧɿ ɮɭɧɤɰɿʀ ɫɢɫɬɟɦ ɨɪɝɚɧɿɡɦɭ (ɜɤɥɸɱɚɸɱɢ ɩɫɢɯɨɥɨɝɿɱɧɿ
ɮɭɧɤɰɿʀ).
ɋɬɪɭɤɬɭɪɢ ɨɪɝɚɧɿɡɦɭ ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɆɄɎ – ɚɧɚɬɨɦɿɱɧɿ ɱɚɫɬɢɧɢ ɬɿɥɚ, ɬɚɤɿ ɹɤ ɨɪɝɚɧɢ, ɤɿɧɰɿɜɤɢ ɬɚ ʀɯ ɤɨɦɩɨɧɟɧɬɢ.
Ɂɞɚɬɧɿɫɬɶ ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɆɄɎ – ɤɜɚɥɿɮɿɤɚɬɨɪ, ɹɤɢɣ ɨɩɢɫɭɽ ɡɞɚɬɧɿɫɬɶ ɨɫɨɛɢ ɜɢɤɨɧɭɜɚɬɢ ɡɚɜɞɚɧɧɹ ɱɢ
ɞɿɸ. ɐɹ ɤɨɧɫɬɪɭɤɰɿɹ ɜɤɚɡɭɽ ɧɚ ɧɚɣɜɢɳɢɣ ɦɨɠɥɢɜɢɣ ɪɿɜɟɧɶ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɨɫɨɛɢ ɭ
ɩɟɜɧɨɦɭ ɞɨɦɟɧɿ ɜ ɩɟɜɧɢɣ ɱɚɫ.
ɏɿɪɨɩɪɚɤɬɢɤɚ ɒɤɨɥɚ ɬɚ ɬɟɱɿɹ ɦɚɧɭɚɥɶɧɨʀ ɬɟɪɚɩɿʀ, ɨɩɢɫɚɧɨʀ Palmer ɜ XIX ɫɬɨɥɿɬɬɿ, ɡɚ ɞɨɩɨɦɨɝɨɸ ɹɤɨʀ ɜ
ɨɪɝɚɧɿɡɦɿ ɜɢɤɨɧɭɸɬɶɫɹ ɪɟɝɭɥɸɜɚɧɧɹ ɧɟɜɟɥɢɤɢɯ ɫɭɝɥɨɛɿɜ. ɐɟ ɟɬɢɦɨɥɨɝɿɱɧɨ ɨɡɧɚɱɚɽ
«ɩɪɚɤɬɢɤɚ ɪɭɤɚɦɢ».
Ⱦɨɫɥɿɞɠɟɧɧɹ ɤɥɿɧɿɱɧɨɝɨ ɇɨɜɚ ɤɨɧɰɟɩɰɿɹ, ɜɢɡɧɚɱɟɧɚ, ɹɤ ɫɮɟɪɚ ɞɨɫɥɿɞɠɟɧɶ ɡ ɦɟɬɨɸ ɨɰɿɧɤɢ ɜɩɥɢɜɭ ɜɬɪɭɱɚɧɶ ɡ
ɜɩɥɢɜɭ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ ɬɚ ɝɪɨɦɚɞɫɶɤɨɝɨ ɡɞɨɪɨɜ'ɹ, ɳɨ ɫɩɪɹɦɨɜɚɧɿ ɧɚ ɨɫɿɛ ɡ ɨɛɦɟɠɟɧɧɹɦɢ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 19
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Ãëîñàð³é (ïðîäîâæåííÿ)
Ʉɨɦɿɬɟɬ ɡ ɟɬɢɤɢ ɩɭɛɥɿɤɚɰɿɣ
(COPE)
Ʉɨɦɩɟɧɫɚɬɨɪɧɿ ɩɪɨɰɟɫɢ
Ʉɨɧɬɟɤɫɬɭɚɥɶɧɿ ɮɚɤɬɨɪɢ
Ȼɟɡɩɟɪɟɪɜɧɢɣ ɩɪɨɮɟɫɿɣɧɢɣ
ɪɨɡɜɢɬɨɤ
Ȼɟɡɩɟɪɟɪɜɧɚ ɦɟɞɢɱɧɚ ɨɫɜɿɬɚ
CINAHL (Ʉɭɦɭɥɹɬɢɜɧɢɣ
ɤɚɬɚɥɨɝ ɥɿɬɟɪɚɬɭɪɢ ɡ
ɫɟɫɬɪɢɧɫɶɤɨʀ ɫɩɪɚɜɿ ɿ
ɫɭɦɿɠɧɢɯ ɩɪɨɮɟɫɿɣ ɡ ɨɯɨɪɨɧɢ
ɡɞɨɪɨɜ’ɹ)
Current Contents
Ɉɛɦɟɠɟɧɧɹ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ
Ɂɚɯɜɨɪɸɜɚɧɧɹ
Ɏɚɤɬɨɪɢ ɫɟɪɟɞɨɜɢɳɚ
ȯɜɪɨɩɟɣɫɶɤɚ ɫɬɪɚɬɟɝɿɹ ɡ
ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɧɚ
2010-2020 ɪɨɤɢ
ȯɜɪɨɩɟɣɫɶɤɿ ɨɪɝɚɧɢ Ɏɿɡɢɱɧɨʀ
ɬɚ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɨʀ Ɇɟɞɢɰɢɧɢ
ȿɤɫɬɪɚɤɨɪɩɨɪɚɥɶɧɚ ɭɞɚɪɧɨ-
ɯɜɢɥɶɨɜɚ ɬɟɪɚɩɿɹ (ȿɍɏɌ)
ɋɩɪɢɹɬɥɢɜɿ ɮɚɤɬɨɪɢ
Ɏɭɧɤɰɿɨɧɚɥɶɧɟ ɨɰɿɧɸɜɚɧɧɹ
Ɏɭɧɤɰɿɨɧɚɥɶɧɨ-ɰɟɧɬɪɢɱɧɟ
Ɏɭɧɤɰɿɨɧɭɜɚɧɧɹ
ɐɿɥɶ-ɫɩɪɹɦɨɜɚɧɢɣ
(ɚɛɨ ɰɿɥɶ-ɨɪɿɽɧɬɨɜɚɧɢɣ ɚɛɨ
ɨɪɿɽɧɬɨɜɚɧɢɣ ɧɚ ɡɚɜɞɚɧɧɹ)
Ⱥɛɿɥɿɬɚɰɿɹ
20 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ɇɟɩɪɢɛɭɬɤɨɜɚ ɨɪɝɚɧɿɡɚɰɿɹ. Ɇɿɫɿɹ ɩɨɥɹɝɚɽ ɭ ɜɢɡɧɚɱɟɧɧɿ ɧɚɣɤɪɚɳɨʀ ɩɪɚɤɬɢɤɢ ɜ ɟɬɢɰɿ
ɜɢɞɚɜɧɢɱɨʀ ɞɿɹɥɶɧɨɫɬɿ.
ɉɪɨɰɟɫɢ, ɳɨ ɚɞɚɩɬɭɸɬɶ ɞɨ ɧɨɜɨɝɨ (ɧɚɛɭɬɨɝɨ) ɫɬɚɧɭ ɡɞɨɪɨɜ'ɹ ɡɚ ɞɨɩɨɦɨɝɨɸ ɦɟɯɚɧɿɡɦɿɜ,
ɡɚɫɧɨɜɚɧɢɯ ɧɚ ɿɧɲɢɯ ɫɬɪɭɤɬɭɪɚɯ / ɮɭɧɤɰɿɹɯ ɨɪɝɚɧɿɡɦɭ, ɩɨɜɟɞɿɧɤɨɜɢɯ ɡɦɿɧɚɯ ɬɚ / ɚɛɨ
ɞɨɩɨɦɿɠɧɢɯ ɩɪɢɫɬɪɨɹɯ (ɩɪɨɬɟɡɚɯ, ɨɪɬɟɡɚɯ ɚɛɨ ɞɨɩɨɦɿɠɧɢɯ ɡɚɫɨɛɚɯ)
Ɉɛɫɬɚɜɢɧɢ, ɹɤɿ ɦɨɠɭɬɶ ɜɩɥɢɧɭɬɢ ɧɚ ɧɚɲɟ ɠɢɬɬɹ ɬɚ ɡɞɨɪɨɜ'ɹ. Ⱦɨ ɤɨɧɬɟɤɫɬɭɚɥɶɧɢɯ ɮɚɤɬɨɪɿɜ
ɜɿɞɧɨɫɹɬɶɫɹ ɡɨɜɧɿɲɧɿ ɮɚɤɬɨɪɢ ɫɟɪɟɞɨɜɢɳɚ ɬɚ ɜɧɭɬɪɿɲɧɿ ɨɫɨɛɢɫɬɿ ɮɚɤɬɨɪɢ.
ɉɪɨɰɟɫ ɜɿɞɫɬɟɠɟɧɧɹ ɬɚ ɞɨɤɭɦɟɧɬɭɜɚɧɧɹ ɡɞɨɛɭɬɢɯ (ɥɿɤɚɪɟɦ ɎɊɆ) ɧɚɜɢɱɨɤ, ɡɧɚɧɶ ɬɚ ɞɨɫɜɿɞɭ
ɹɤ ɨɮɿɰɿɣɧɨ, ɬɚɤ ɿ ɧɟɨɮɿɰɿɣɧɨ ɩɿɞ ɱɚɫ ɪɨɛɨɬɢ, ɡɚ ɦɟɠɚɦɢ ɩɨɱɚɬɤɨɜɨɝɨ ɧɚɜɱɚɧɧɹ.
Ɉɫɜɿɬɧɹ ɞɿɹɥɶɧɿɫɬɶ, ɫɩɪɹɦɨɜɚɧɚ ɧɚ ɩɿɞɬɪɢɦɤɭ, ɪɨɡɜɢɬɨɤ ɬɚ ɩɿɞɜɢɳɟɧɧɹ ɡɧɚɧɶ, ɧɚɜɢɱɨɤ ɬɚ
ɩɪɨɮɟɫɿɣɧɨʀ ɪɨɛɨɬɢ, ɹɤɿ ɥɿɤɚɪ ɎɊɆ ɜɢɤɨɪɢɫɬɨɜɭɽ ɩɪɨɬɹɝɨɦ ɧɚɞɚɧɧɹ ɩɨɫɥɭɝ ɜ ɨɯɨɪɨɧɿ
ɡɞɨɪɨɜ’ɹ.
Ʉɚɬɚɥɨɝ ɫɬɚɬɟɣ ɚɧɝɥɨɦɨɜɧɢɯ ɠɭɪɧɚɥɿɜ ɬɚ ɨɤɪɟɦɢɯ ɠɭɪɧɚɥɿɜ ɧɚ ɿɧɲɢɯ ɦɨɜɚɯ ɡ ɫɟɫɬɪɢɧɫɶɤɨʀ
ɫɩɪɚɜɢ, ɫɭɦɿɠɧɢɯ ɩɪɨɮɟɫɿɣ, ɛɿɨɦɟɞɢɰɢɧɢ ɬɚ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ.
ɋɟɪɜɿɫɧɚ ɛɚɡɚ ɞɚɧɢɯ ɡɿ ɲɜɢɞɤɢɦ ɨɩɨɜɿɳɟɧɧɹɦ ɜɿɞ Institute for Scientific Information, ɳɨ
ɡɚɪɚɡ ɽ ɱɚɫɬɢɧɨɸ Thomson Reuters, ɡ ɨɧɥɚɣɧ ɞɨɫɬɭɩɨɦ ɬɚ ɞɪɭɤɨɜɚɧɢɦɢ ɜɟɪɫɿɹɦɢ ɜ
ɞɟɤɿɥɶɤɨɯ ɪɿɡɧɢɯ ɬɟɦɚɬɢɱɧɢɯ ɪɨɡɞɿɥɚɯ.
Ɂɚɝɚɥɶɧɢɣ ɬɟɪɦɿɧ, ɹɤɢɣ ɨɯɨɩɥɸɽ ɩɨɪɭɲɟɧɧɹ, ɨɛɦɟɠɟɧɧɹ ɚɤɬɢɜɧɨɫɬɿ ɬɚ ɨɛɦɟɠɟɧɧɹ
ɦɨɠɥɢɜɨɫɬɿ ɭɱɚɫɬɿ, ɹɤɿ ɦɨɠɭɬɶ ɛɭɬɢ ɜɢɡɧɚɱɟɧɿ ɹɤ ɩɪɨɛɥɟɦɚ ɨɫɨɛɢ, ɳɨ ɜɢɤɨɧɭɽ ɞɿʀ, ɹɤɿ ɜɿɧ
ɚɛɨ ɜɨɧɚ ɩɨɬɪɟɛɭɽ ɬɚ ɯɨɱɟ ɪɨɛɢɬɢ, ɱɟɪɟɡ ɬɟ, ɳɨ ɨɫɧɨɜɧɢɣ ɫɬɚɧ ɡɞɨɪɨɜ'ɹ – ɯɜɨɪɨɛɚ, ɬɪɚɜɦɚ
ɚɛɨ ɧɚɜɿɬɶ ɫɬɚɪɿɧɧɹ – ɜɩɥɢɜɚɽ ɧɚ ɣɨɝɨ ɚɛɨ ʀʀ ɜɢɤɨɧɚɧɧɹ ɜ ɣɨɝɨ ɱɢ ʀʀ ɪɟɚɥɶɧɨɦɭ ɫɟɪɟɞɨɜɢɳɿ.
Ɋɨɡɥɚɞ ɫɬɪɭɤɬɭɪɢ ɚɛɨ ɮɭɧɤɰɿʀ, ɹɤɢɣ ɮɨɪɦɭɽ ɫɩɟɰɢɮɿɱɧɿ ɫɢɦɩɬɨɦɢ ɚɛɨ ɭɪɚɠɟɧɧɹ
ɤɨɧɤɪɟɬɧɨʀ ɥɨɤɚɥɿɡɚɰɿʀ, ɳɨ ɧɟ ɽ ɩɪɨɫɬɨ ɩɪɹɦɢɦ ɪɟɡɭɥɶɬɚɬɨɦ ɮɿɡɢɱɧɨɝɨ ɭɲɤɨɞɠɟɧɧɹ
ɋɟɪɟɞ ɤɨɧɬɟɤɫɬɭɚɥɶɧɢɯ ɮɚɤɬɨɪɿɜ ɽ ɡɨɜɧɿɲɧɿɦɢ ɮɚɤɬɨɪɚɦɢ (ɧɚɩɪ. ɫɨɰɿɚɥɶɧɿ ɫɬɚɜɥɟɧɧɹ,
ɨɫɨɛɥɢɜɨɫɬɿ ɚɪɯɿɬɟɤɬɭɪɢ, ɩɪɚɜɨɜɿ ɬɚ ɫɨɰɿɚɥɶɧɿ ɫɬɪɭɤɬɭɪɢ, ɚ ɬɚɤɨɠ ɤɥɿɦɚɬ, ɦɿɫɰɟɜɿɫɬɶ ɬɨɳɨ)
ɋɬɪɚɬɟɝɿɹ ɳɨɞɨ ɡɛɿɥɶɲɟɧɧɹ ɭɱɚɫɬɿ ɥɸɞɟɣ ɡ ɨɛɦɟɠɟɧɧɹɦɢ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɜ ɫɭɫɩɿɥɶɫɬɜɿ ɬɚ
ɟɤɨɧɨɦɿɰɿ ɬɚ ɭɦɨɠɥɢɜɥɟɧɧɹ ɡɞɿɣɫɧɸɜɚɬɢ ɫɜɨʀ ɩɪɚɜɚ ɩɨɜɧɨɸ ɦɿɪɨɸ.
ɑɨɬɢɪɢ ɽɜɪɨɩɟɣɫɶɤɿ ɨɪɝɚɧɿɡɚɰɿʀ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ: ȯɜɪɨɩɟɣɫɶɤɚ
ɚɤɚɞɟɦɿɹ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ (ȯȺɊɆ), ȯɜɪɨɩɟɣɫɶɤɟ ɬɨɜɚɪɢɫɬɜɨ ɮɿɡɢɱɧɨʀ ɬɚ
ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ (ȯɌɎɊɆ), ɋɟɤɰɿɹ ɡ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ
ȯɜɪɨɩɟɣɫɶɤɨɝɨ ɋɨɸɡɭ Ɇɟɞɢɱɧɢɯ ɋɩɟɰɿɚɥɿɫɬɿɜ (ɋɟɤɰɿɹ ɎɊɆ ȯɋɆɋ) ɬɚ ȯɜɪɨɩɟɣɫɶɤɢɣ
Ʉɨɥɟɞɠ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ (ɨɛɫɥɭɝɨɜɭɽɬɶɫɹ Ɋɚɞɨɸ ɎɊɆ ȯɋɆɋ).
ɇɟɿɧɜɚɡɢɜɧɚ ɯɿɪɭɪɝɿɱɧɚ ɩɪɨɰɟɞɭɪɚ, ɳɨ ɜɢɤɨɪɢɫɬɨɜɭɽ ɪɿɡɤɿ ɜɢɫɨɤɨɚɦɩɥɿɬɭɞɧɿ ɿɦɩɭɥɶɫɢ
ɦɟɯɚɧɿɱɧɨʀ ɟɧɟɪɝɿʀ, ɩɨɞɿɛɧɿ ɞɨ ɡɜɭɤɨɜɢɯ ɯɜɢɥɶ, ɹɤɿ ɝɟɧɟɪɭɸɬɶɫɹ ɟɥɟɤɬɪɨɦɚɝɧɿɬɧɨɸ
ɤɨɬɭɲɤɨɸ ɚɛɨ ɫɩɚɥɚɯɨɦ ɭ ɜɨɞɿ ɞɥɹ ɫɬɢɦɭɥɹɰɿʀ ɡɚɝɨɽɧɧɹ ɞɟɹɤɢɯ ɮɿɡɢɱɧɢɯ ɪɨɡɥɚɞɿɜ
("ȿɤɫɬɪɚɤɨɪɩɨɪɚɥɶɧɟ" ɨɡɧɚɱɚɽ, ɳɨ ɭɞɚɪɧɿ ɯɜɢɥɿ ɝɟɧɟɪɭɸɬɶɫɹ ɡɡɨɜɧɿ ɞɨ ɬɿɥɚ ɿ ɩɟɪɟɞɚɸɬɶɫɹ ɡ
ɤɨɬɭɲɤɢ ɱɟɪɟɡ ɲɤɿɪɭ).
Ɏɚɤɬɨɪɢ ɫɟɪɟɞɨɜɢɳɚ, ɳɨ ɩɨɥɿɩɲɭɸɬɶ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ / ɡɦɟɧɲɭɸɬɶ ɨɛɦɟɠɟɧɧɹ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ
ȼɢɡɧɚɱɟɧɧɹ ɪɿɜɧɹ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɨɫɨɛɢ ɬɚ ɦɨɠɥɢɜɨɫɬɿ ɜɢɤɨɧɭɜɚɬɢ ɩɨɜɫɹɤɞɟɧɧɿ ɡɚɜɞɚɧɧɹ
ɬɚ ɩɨɬɪɟɛɢ ɠɢɬɬɹ.
Ȼɭɞɶ-ɹɤɟ ɜɬɪɭɱɚɧɧɹ ɜ ɨɯɨɪɨɧɿ ɡɞɨɪɨɜ'ɹ, ɫɩɪɹɦɨɜɚɧɟ ɧɚ ɩɨɤɪɚɳɟɧɧɹ / ɜɿɞɧɨɜɥɟɧɧɹ ɮɭɧɤɰɿɣ
ɨɪɝɚɧɿɡɦɭ
ȼɫɟ, ɳɨ ɪɨɛɥɹɬɶ ɥɸɞɫɶɤɿ ɨɪɝɚɧɿɡɦɢ, ɬɚ ɞɿʀ, ɹɤɿ ɜɢɤɨɧɭɸɬɶ ɥɸɞɢ. ɍ ɆɄɎ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ
ɩɪɚɰɸɽ ɡ ɬɨɱɤɢ ɡɨɪɭ ɞɨɦɟɧɿɜ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ, ɿ ɰɿ ɞɨɦɟɧɢ ɩɨɞɿɥɹɸɬɶɫɹ ɧɚ ɜɢɦɿɪɢ Ɏɭɧɤɰɿɣ
ɬɚ ɋɬɪɭɤɬɭɪ Ɉɪɝɚɧɿɡɦɭ, Ⱥɤɬɢɜɧɨɫɬɿ ɬɚ ɍɱɚɫɬɿ. Ɏɭɧɤɰɿɨɧɭɜɚɧɧɹ ɽ ɡɚɝɚɥɶɧɢɦ ɬɟɪɦɿɧɨɦ, ɳɨ
ɨɩɢɫɭɽ ɜɡɚɽɦɨɞɿɸ ɨɫɨɛɢ ɬɚ ɫɬɚɧɭ ɡɞɨɪɨɜ'ɹ ɜ ʀʀ/ɣɨɝɨ ɫɟɪɟɞɨɜɢɳɿ (ɜɢɡɧɚɱɟɧɨ ɜ Ɇɿɠɧɚɪɨɞɧɿɣ
ɤɥɚɫɢɮɿɤɚɰɿʀ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ, ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɬɚ ɡɞɨɪɨɜ'ɹ, ȼɈɈɁ 2001)
Ʉɚɠɭɬɶ ɩɪɨ ɜɩɪɚɜɢ, ɡɚɫɧɨɜɚɧɿ ɧɚ ɩɪɚɤɬɢɰɿ ɰɿɥɟɫɩɪɹɦɨɜɚɧɢɯ ɪɭɯɨɜɢɯ ɞɿɣ
ɍ ɦɟɠɚɯ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ ɰɟɣ ɬɟɪɦɿɧ ɜɿɞɧɨɫɢɬɶɫɹ ɞɨ ɱɚɫɬɢɧɢ
ɪɟɚɛɿɥɿɬɚɰɿʀ, ɹɤɚ ɫɬɨɫɭɽɬɶɫɹ ɜɿɤɭ ɡɪɨɫɬɚɧɧɹ, ɤɨɥɢ ɧɟ ɜɫɿ ɮɭɧɤɰɿʀ ɛɭɥɢ ɪɨɡɜɢɧɭɬɿ, ɿ ɤɨɥɢ
ɜɿɞɩɨɜɿɞɧɨ ɯɜɨɪɨɛɢ ɬɚ ɩɨɪɭɲɟɧɧɹ ɦɨɠɭɬɶ ɧɟɝɚɬɢɜɧɨ ɜɩɥɢɜɚɬɢ ɧɚ ɩɪɚɜɢɥɶɧɢɣ ɪɨɡɜɢɬɨɤ
ɞɟɹɤɢɯ ɿɧɲɢɯ ɧɨɪɦɚɥɶɧɢɯ ɮɭɧɤɰɿɣ.
¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Ãëîñàð³é (ïðîäîâæåííÿ)

ɋɬɚɧ ɡɞɨɪɨɜ'ɹ ɋɢɬɭɚɰɿɹ, ɹɤɚ ɩɟɪɟɲɤɨɞɠɚɽ ɡɞɨɪɨɜ'ɸ (ɯɜɨɪɨɛɢ, ɪɨɡɥɚɞɢ ɬɚ ɬɪɚɜɦɢ). ȼ ɆɄɎ ɨɛɦɟɠɟɧɧɹ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɬɚ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɪɨɡɝɥɹɞɚɸɬɶɫɹ ɹɤ ɪɟɡɭɥɶɬɚɬɢ ɜɡɚɽɦɨɞɿʀ ɦɿɠ ɫɬɚɧɚɦɢ
ɡɞɨɪɨɜ'ɹ (ɯɜɨɪɨɛɚɦɢ, ɪɨɡɥɚɞɚɦɢ ɬɚ ɬɪɚɜɦɚɦɢ) ɬɚ ɤɨɧɬɟɤɫɬɭɚɥɶɧɢɦɢ ɮɚɤɬɨɪɚɦɢ.
ɏɨɥɿɡɦ Ʌɿɤɭɜɚɧɧɹ ɜɫɿɽʀ ɨɫɨɛɢ ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɩɫɢɯɿɱɧɢɯ ɬɚ ɫɨɰɿɚɥɶɧɢɯ ɮɚɤɬɨɪɿɜ, ɧɟ ɬɿɥɶɤɢ
ɫɢɦɩɬɨɦɿɜ ɡɚɯɜɨɪɸɜɚɧɧɹ. ɍ ɎɊɆ ɜɨɧɨ ɧɟ ɜɢɤɨɪɢɫɬɨɜɭɽɬɶɫɹ ɞɥɹ ɜɢɩɪɚɜɞɚɧɧɹ ɧɚɭɤɨɜɨ
ɧɟɩɿɞɬɜɟɪɞɠɟɧɢɯ ɦɟɬɨɞɿɜ ɥɿɤɭɜɚɧɧɹ, ɨɫɤɿɥɶɤɢ ɎɊɆ – ɰɟ ɩɟɪɜɢɧɧɚ ɦɟɞɢɱɧɚ ɫɩɟɰɿɚɥɶɧɿɫɬɶ,
ɩɨɜɧɿɫɬɸ ɡɚɫɧɨɜɚɧɚ ɧɚ ɞɨɤɚɡɚɯ
ɉɨɪɭɲɟɧɧɹ ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɆɄɎ – ɩɪɨɛɥɟɦɢ ɭ ɮɭɧɤɰɿʀ ɚɛɨ ɫɬɪɭɤɬɭɪɿ ɨɪɝɚɧɿɡɦɭ, ɬɚɤɿ, ɹɤ ɡɧɚɱɧɟ
ɜɿɞɯɢɥɟɧɧɹ ɚɛɨ ɜɬɪɚɬɚ.
Ⱦɨɫɥɿɞɠɟɧɧɹ ɜɩɪɨɜɚɞɠɟɧɧɹ Ɉɰɿɧɤɚ ɿɧɬɟɪɜɟɧɰɿɣ ɜ ɫɮɟɪɿ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ’ɹ ɜɞɨɦɚ, ɜ ɭɦɨɜɚɯ «ɪɟɚɥɶɧɨɝɨ ɫɜɿɬɭ»
Ɇɿɠ-ɞɢɫɰɢɩɥɿɧɚɪɧɿ ȼɢɤɨɧɭɸɬɶɫɹ ɜ ɤɨɦɚɧɞɚɯ, ɹɤɿ ɜɤɥɸɱɚɸɬɶ ɪɿɡɧɿ ɞɢɫɰɢɩɥɿɧɢ ɚɛɨ ɫɭɤɭɩɧɿɫɬɶ ɫɩɟɰɿɚɥɿɡɨɜɚɧɢɯ
ɞɨɫɥɿɞɠɟɧɧɹ ɡɧɚɧɶ
ɉɪɨɰɟɫɢ ɧɚɜɱɚɧɧɹ ɍ ɎɊɆ – ɧɨɜɿ ɪɭɯɨɜɿ ɬɚ ɩɨɜɟɞɿɧɤɨɜɿ ɫɬɪɚɬɟɝɿʀ, ɹɤɿ ɦɚɸɬɶ ɛɭɬɢ ɜɢɜɱɟɧɿ, ɳɨɛ ɩɪɨɬɢɞɿɹɬɢ
ɨɛɦɟɠɟɧɧɸ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɬɚ ɩɨɥɿɩɲɢɬɢ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɩɪɢ ɩɟɜɧɨɦɭ ɫɬɚɧɿ ɡɞɨɪɨɜ'ɹ.
Ɂɞɨɪɨɜ'ɹ ɠɢɬɬɹ ȯ ɪɿɜɧɟɦ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɨɫɨɛɢ ɜ ɣɨɝɨ/ʀʀ ɬɟɩɟɪɿɲɧɶɨɦɭ ɫɟɪɟɞɨɜɢɳɿ, ɹɤɢɣ ɡɚɥɟɠɢɬɶ ɹɤ ɜɿɞ
ɫɟɪɟɞɨɜɢɳɚ ɥɸɞɢɧɢ, ɬɚɤ ɿ ɜɿɞ ɛɿɨɥɨɝɿɱɧɨɝɨ ɡɞɨɪɨɜ'ɹ.
Ⱦɨɜɝɨɬɪɢɜɚɥɚ ɮɚɡɚ ȼɿɞɧɨɫɢɬɶɫɹ ɞɨ ɞɨɜɝɨɬɪɢɜɚɥɨɝɨ ɩɟɪɿɨɞɭ ɩɿɫɥɹ ɩɿɞɝɨɫɬɪɨʀ ɮɚɡɢ ɞɥɹ ɨɫɿɛ, ɹɤɿ ɦɚɸɬɶ ɯɪɨɧɿɱɧɿ
ɡɚɯɜɨɪɸɜɚɧɧɹ ɬɚ ɞɨɜɝɨɬɪɢɜɚɥɿ ɨɛɦɟɠɟɧɧɹ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɚɛɨ ɬɪɭɞɧɨɳɿ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ,
ɤɨɥɢ ɫɢɬɭɚɰɿɹ ɫɬɚɛɿɥɿɡɭɽɬɶɫɹ; ɚɤɰɟɧɬ ɪɨɛɢɬɶɫɹ ɧɚ ɩɿɞɬɪɢɦɰɿ ɬɚ ɜɬɨɪɢɧɧɿɣ ɩɪɨɮɿɥɚɤɬɢɰɿ.
Ɇɚɧɭɚɥɶɧɚ ɦɟɞɢɰɢɧɚ Ⱦɢɫɰɢɩɥɿɧɚ, ɹɤɚ ɜɤɥɸɱɚɽ ɜ ɫɟɛɟ ɜɫɿ ɞɿɸɱɿ ɦɟɬɨɞɢ ɞɿɚɝɧɨɫɬɢɤɢ, ɨɰɿɧɸɜɚɧɧɹ ɬɚ ɜɬɪɭɱɚɧɧɹ,
ɹɤɿ ɦɨɠɟ ɜɢɤɨɧɚɬɢ ɤɜɚɥɿɮɿɤɨɜɚɧɢɣ ɥɿɤɚɪ, ɜɢɤɨɪɢɫɬɨɜɭɸɱɢ ɩɟɪɟɜɚɠɧɨ ɫɜɨʀ ɞɨɫɜɿɞɱɟɧɿ ɪɭɤɢ.
ȼɨɧɚ ɜɤɥɸɱɚɽ ɹɤ ɦ'ɹɤɨ-ɬɤɚɧɢɧɧɿ, ɬɚɤ ɿ ɫɬɪɭɤɬɭɪɧɿ ɬɟɯɧɿɤɢ.
Ɇɟɯɚɧɨɬɟɪɚɩɿɹ Ɇɨɞɚɥɶɧɿɫɬɶ ɮɿɡɢɱɧɨɝɨ ɜɬɪɭɱɚɧɧɹ, ɪɨɡɪɨɛɥɟɧɚ Zander ɭ XIX ɫɬɨɥɿɬɬɿ ɿ ɬɚɤɚ, ɳɨ
ɫɤɥɚɞɚɽɬɶɫɹ ɡ ɜɢɤɨɧɚɧɧɹ ɬɟɪɚɩɟɜɬɢɱɧɢɯ ɜɩɪɚɜ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɦɟɯɚɧɿɱɧɢɯ ɩɪɢɫɬɪɨʀɜ.
Ɇɟɞɢɱɧɚ ɞɿɚɝɧɨɫɬɢɤɚ Ʉɥɚɫɢɱɧɢɣ ɩɪɨɰɟɫ ɞɿɚɝɧɨɫɬɢɤɢ ɥɿɤɚɪɹɦɢ.
MEDLINE (Medical Literature Analysis and Retrieval System Online, ɚɛɨ MEDLARS Online) –
ɛɿɛɥɿɨɝɪɚɮɿɱɧɚ ɛɚɡɚ ɞɚɧɢɯ ɡ ɩɪɢɪɨɞɧɢɱɢɯ ɧɚɭɤ ɬɚ ɛɿɨɦɟɞɢɱɧɨʀ ɿɧɮɨɪɦɚɰɿʀ.
ɋɩɿɥɶɧɚ ɤɨɦɚɧɞɧɚ ɞɿɹ ɞɢɜ. ɧɢɠɱɟ «ɤɨɦɚɧɞɚ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ»
Ɇɭɥɶɬɢɦɨɞɚɥɶɧɢɣ ɩɿɞɯɿɞ ɑɟɪɟɡ ɮɨɤɭɫ ɧɚ ɩɨɪɭɲɟɧɧɹ, ɨɛɦɟɠɟɧɧɹ ɚɤɬɢɜɧɨɫɬɿ ɬɚ ɨɛɦɟɠɟɧɧɹ ɭɱɚɫɬɿ, ɭɜɚɝɭ ɞɨ
ɨɫɨɛɢɫɬɢɯ ɮɚɤɬɨɪɿɜ ɬɚ ɮɚɤɬɨɪɿɜ ɫɟɪɟɞɨɜɢɳɚ ɬɚ ɦɭɥɶɬɢ-ɩɪɨɮɟɫɿɣɧɭ ɤɨɦɚɧɞɭ, ɩɿɞɯɿɞ ɞɨ
ɎɊɆ ɪɿɞɤɨ ʉɪɭɧɬɭɽɬɶɫɹ ɧɚ ɨɞɧɨɦɭ ɜɬɪɭɱɚɧɧɿ. ɍ ɮɿɡɢɱɧɿɣ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɿɣ ɦɟɞɢɰɢɧɿ
ɩɚɰɿɽɧɬɢ ɡɚɡɜɢɱɚɣ ɥɿɤɭɸɬɶɫɹ ɿɡ ɡɚɫɬɨɫɭɜɚɧɧɹɦ ɲɢɪɨɤɨɝɨ ɫɩɟɤɬɪɭ ɜɬɪɭɱɚɧɶ, ɳɨ
ɡɚɛɟɡɩɟɱɭɸɬɶɫɹ ɲɢɪɨɤɢɦ ɤɨɥɨɦ ɮɚɯɿɜɰɿɜ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ’ɹ. ȼɨɧɢ ɦɨɠɭɬɶ ɜɤɥɸɱɚɬɢ,
ɡɨɤɪɟɦɚ, ɬɟɪɚɩɿɸ ɜɩɪɚɜɚɦɢ, ɟɪɝɨɬɟɪɚɩɿɸ, ɬɟɪɚɩɿɸ ɦɨɜɥɟɧɧɹ, ɧɟɣɪɨɩɫɢɯɨɥɨɝɿɱɧɿ ɦɟɬɨɞɢ
ɜɬɪɭɱɚɧɧɹ, ɩɨɜɟɞɿɧɤɨɜɭ ɬɟɪɚɩɿɸ, ɮɿɡɢɱɧɭ ɬɟɪɚɩɿɸ, ɦɚɧɭɚɥɶɧɭ ɬɟɪɚɩɿɸ. Ʉɨɠɟɧ ɩɚɰɿɽɧɬ
ɥɿɤɭɽɬɶɫɹ ɿɡ ɡɚɫɬɨɫɭɜɚɧɧɹɦ ɭɧɿɤɚɥɶɧɨɝɨ ɩɿɞɯɨɞɭ, ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɣɨɝɨ ɡɚɯɜɨɪɸɜɚɧɧɹ,
ɩɨɪɭɲɟɧɶ, ɨɛɦɟɠɟɧɶ ɚɤɬɢɜɧɨɫɬɿ, ɨɛɦɟɠɟɧɶ ɦɨɠɥɢɜɨɫɬɿ ɭɱɚɫɬɿ, ɮɚɤɬɨɪɿɜ ɫɟɪɟɞɨɜɢɳɚ ɬɚ
ɨɫɨɛɢɫɬɢɯ ɮɚɤɬɨɪɿɜ, ɜ ɪɚɦɤɚɯ ɩɨɜɧɿɫɬɸ ɦɭɥɶɬɢɦɨɞɚɥɶɧɨɝɨ ɬɚ ɿɧɞɢɜɿɞɭɚɥɿɡɨɜɚɧɨɝɨ ɩɿɞɯɨɞɭ.
Ɇɭɥɶɬɢ-ɩɪɨɮɟɫɿɣɧɢɣ Ʉɚɠɭɬɶ ɩɪɨ ɪɟɚɛɿɥɿɬɚɰɿɣɧɭ ɤɨɦɚɧɞɭ, ɱɢʀ ɱɥɟɧɢ ɡɚɡɜɢɱɚɣ ɧɚɥɟɠɚɬɶ ɞɨ ɪɿɡɧɢɯ ɩɪɨɮɟɫɿɣɧɢɯ
ɫɮɟɪ (ɧɚɩɪ. ɮɿɡɢɱɧɿ ɬɟɪɚɩɟɜɬɢ, ɬɟɪɚɩɟɜɬɢ ɦɨɜɢ ɬɚ ɦɨɜɥɟɧɧɹ, ɟɪɝɨɬɟɪɚɩɟɜɬɢ ɬɨɳɨ).
Ɇɭɥɶɬɢ-ɩɪɨɮɟɫɿɣɧɚ ɤɨɦɚɧɞɚ ɞɢɜ. ɧɢɠɱɟ «ɤɨɦɚɧɞɚ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ»
ɇɟɣɪɨɩɥɚɫɬɢɱɧɿɫɬɶ ȼɢɤɨɪɢɫɬɨɜɭɽɬɶɫɹ ɞɥɹ ɨɩɢɫɭ ɠɢɬɬɽɜɨɝɨ ɞɨɫɜɿɞɭ ɪɟɦɨɞɟɥɸɜɚɧɧɹ ɦɟɪɟɠ ɝɨɥɨɜɧɨɝɨ ɦɨɡɤɭ,
(ɚɛɨ ɩɥɚɫɬɢɱɧɿɫɬɶ ɦɨɡɤɭ) ɳɨ ɫɬɢɦɭɥɸɽɬɶɫɹ ɞɨɫɜɿɞɨɦ, ɬɚ ɨɫɨɛɥɢɜɨ ɱɚɫɬɨ ɬɪɚɩɥɹɽɬɶɫɹ ɜ ɞɢɬɢɧɫɬɜɿ ɬɚ ɨɞɪɚɡɭ ɩɿɫɥɹ
ɭɪɚɠɟɧɧɹ ɝɨɥɨɜɧɨɝɨ ɦɨɡɤɭ.
Ɉɫɬɟɨɩɚɬɿɹ ɒɤɨɥɚ ɿ ɧɚɩɪɹɦɨɤ ɦɚɧɭɚɥɶɧɨʀ ɬɟɪɚɩɿʀ, ɫɬɜɨɪɟɧɚ Still ɜ XIX ɫɬɨɥɿɬɬɿ, ɹɤɚ ɨɰɿɧɸɽ ɿ ɥɿɤɭɽ ɪɿɡɧɿ
ɮɿɡɢɱɧɿ ɪɨɡɥɚɞɢ ɲɥɹɯɨɦ ɤɨɪɢɝɭɜɚɧɧɹ ɫɭɝɥɨɛɿɜ. ɐɟ ɟɬɢɦɨɥɨɝɿɱɧɨ ɨɡɧɚɱɚɽ «ɲɥɹɯ ɤɿɫɬɨɤ».
ɍɱɚɫɬɶ ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɆɄɎ – ɡɚɥɭɱɟɧɧɹ ɞɨ ɠɢɬɬɽɜɨʀ ɫɢɬɭɚɰɿʀ.
Ɉɛɦɟɠɟɧɧɹ ɦɨɠɥɢɜɨɫɬɿ ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɆɄɎ – ɩɪɨɛɥɟɦɢ, ɹɤɿ ɥɸɞɢɧɚ ɦɨɠɟ ɡɚɡɧɚɜɚɬɢ ɩɪɢ ɡɚɥɭɱɟɧɧɿ ɞɨ ɠɢɬɬɽɜɢɯ
ɭɱɚɫɬɿ ɫɢɬɭɚɰɿɣ.
ɋɢɫɬɟɦɚ ɤɥɚɫɢɮɿɤɚɰɿʀ ɐɟ ɫɢɫɬɟɦɚ ɤɥɚɫɢɮɿɤɭɜɚɧɧɹ ɩɚɰɿɽɧɬɿɜ ɭ ɨɞɧɨɪɿɞɧɢɯ ɝɪɭɩɚɯ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ʀɯ ɩɨɬɪɟɛ ɜ
ɩɚɰɿɽɧɬɿɜ ɞɨɩɨɦɨɡɿ ɬɚ ɩɨɜ'ɹɡɚɧɨɝɨ ɮɿɧɚɧɫɭɜɚɧɧɹ.
ɉɚɰɿɽɧɬ-ɰɟɧɬɪɢɱɧɟ Ȼɭɞɶ-ɹɤɟ ɜɬɪɭɱɚɧɧɹ ɜ ɨɯɨɪɨɧɿ ɡɞɨɪɨɜ'ɹ, ɫɩɪɹɦɨɜɚɧɟ ɧɚ ɩɨɤɪɚɳɟɧɧɹ ɡɚɝɚɥɶɧɨɝɨ
ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ /ɛɥɚɝɨɩɨɥɭɱɱɹ ɿɧɞɢɜɿɞɭɭɦɚ
Ɋɿɜɧɢɣ ɤɨɧɫɭɥɶɬɚɧɬ ɐɟ ɨɫɨɛɚ, ɹɤɚ ɦɚɽ ɫɬɚɬɭɫ ɡɞɨɪɨɜ'ɹ ɱɢ ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ, ɬɚɤɢɣ ɠɟ, ɹɤ ɭ ɩɚɰɿɽɧɬɚ, ɿ
ɹɤɚ ɧɚɞɚɽ ɤɨɧɫɭɥɶɬɚɰɿʀ, ɜɤɥɸɱɚɸɱɢ ɟɦɨɰɿɣɧɭ ɬɚ ɿɧɮɨɪɦɚɰɿɣɧɭ ɞɨɩɨɦɨɝɭ ɬɚ ɡɚɨɯɨɱɟɧɧɹ.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 21
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Ãëîñàð³é (ïðîäîâæåííÿ)

ȼɢɤɨɧɚɧɧɹ ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɆɄɎ – ɤɜɚɥɿɮɿɤɚɬɨɪ, ɹɤɢɣ ɨɩɢɫɭɽ ɬɟ, ɳɨ ɪɨɛɢɬɶ ɥɸɞɢɧɚ ɜ ʀʀ ɚɤɬɭɚɥɶɧɨɦɭ
ɫɟɪɟɞɨɜɢɳɿ. Ɉɫɤɿɥɶɤɢ ɚɤɬɭɚɥɶɧɟ ɫɟɪɟɞɨɜɢɳɟ ɡɚɜɠɞɢ ɜɤɥɸɱɚɽ ɜ ɫɟɛɟ ɡɚɝɚɥɶɧɢɣ ɫɨɰɿɚɥɶɧɢɣ
ɤɨɧɬɟɤɫɬ, ɜɢɤɨɧɚɧɧɹ ɬɚɤɨɠ ɦɨɠɟ ɪɨɡɭɦɿɬɢɫɶ, ɹɤ «ɡɚɥɭɱɟɧɧɹ ɞɨ ɠɢɬɬɽɜɨʀ ɫɢɬɭɚɰɿʀ» ɚɛɨ
«ɠɢɬɬɽɜɢɣ ɞɨɫɜɿɞ» ɥɸɞɟɣ ɭ ʀɯ ɮɚɤɬɢɱɧɨɦɭ ɤɨɧɬɟɤɫɬɿ.
Ɉɫɨɛɢɫɬɿ ɮɚɤɬɨɪɢ ɋɟɪɟɞ ɤɨɧɬɟɤɫɬɭɚɥɶɧɢɯ ɮɚɤɬɨɪɿɜ ɽ ɜɧɭɬɪɿɲɧɿ ɮɚɤɬɨɪɢ, ɹɤɿ ɜɤɥɸɱɚɸɬɶ ɫɬɚɬɶ, ɜɿɤ, ɫɬɢɥɿ
ɩɨɞɨɥɚɧɧɹ, ɫɨɰɿɚɥɶɧɢɣ ɫɬɚɧ, ɨɫɜɿɬɭ, ɩɪɨɮɟɫɿɸ, ɦɢɧɭɥɢɣ ɬɚ ɩɨɬɨɱɧɢɣ ɞɨɫɜɿɞ, ɡɚɝɚɥɶɧɿ
ɩɨɜɟɞɿɧɤɨɜɿ ɦɨɞɟɥɿ, ɯɚɪɚɤɬɟɪ ɬɚ ɿɧɲɿ ɮɚɤɬɨɪɢ, ɹɤɿ ɜɩɥɢɜɚɸɬɶ ɧɚ ɬɟ, ɹɤ ɥɸɞɢɧɨɸ ɡɚɡɧɚɽɬɶɫɹ
ɨɛɦɟɠɟɧɧɹ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ.
Ɏɿɡɢɱɧɢɣ ɚɝɟɧɬ Ɏɨɪɦɚ ɚɛɨ ɫɩɨɫɿɛ ɫɢɫɬɟɦɧɨɝɨ ɡɚɫɬɨɫɭɜɚɧɧɹ ɮɿɡɢɱɧɨʀ ɟɧɟɪɝɿʀ ɞɨ ɠɢɜɢɯ ɬɤɚɧɢɧ ɞɥɹ ɜɩɥɢɜɭ
ɧɚ ɮɿɡɿɨɥɨɝɿɱɧɿ ɩɪɨɰɟɫɢ ɭ ɩɨɽɞɧɚɧɧɿ ɡ ɚɛɨ ɞɥɹ ɬɟɪɚɩɟɜɬɢɱɧɢɯ ɰɿɥɟɣ. Ɏɿɡɢɱɧɿ ɚɝɟɧɬɢ
ɜɤɥɸɱɚɸɬɶ ɪɿɡɧɿ ɩɪɟɮɨɪɦɨɜɚɧɿ ɱɢɧɧɢɤɢ, ɬɚɤɿ ɹɤ ɬɟɪɦɿɱɧɿ, ɚɤɭɫɬɢɱɧɿ, ɜɨɞɧɿ, ɦɟɯɚɧɿɱɧɿ,
ɟɥɟɤɬɪɢɱɧɿ, ɦɚɝɧɿɬɧɿ ɚɛɨ ɫɜɿɬɨɜɿ. ȿɬɢɦɨɥɨɝɿɱɧɨ ɰɟ ɨɡɧɚɱɚɽ «ɚɝɟɧɬɢ ɩɪɢɪɨɞɢ», ɿ, ɧɚɫɩɪɚɜɞɿ,
ɞɟɹɤɿ ɮɿɡɢɱɧɿ ɚɝɟɧɬɢ ɜɫɟ ɳɟ ɡɚɫɬɨɫɨɜɭɸɬɶɫɹ ɛɟɡ ɛɭɞɶ-ɹɤɢɯ ɦɨɞɢɮɿɤɚɰɿɣ ɜɿɞɧɨɫɧɨ ɫɜɨɽʀ
ɩɪɢɪɨɞɢ.
Ɏɿɡɢɱɧɚ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɚ ɋɭɱɚɫɧɟ ɜɢɡɧɚɱɟɧɧɹ ɫɩɟɰɿɚɥɶɧɨɫɬɿ ɜɿɞɩɨɜɿɞɧɨ ɞɨ Ȼɿɥɨʀ Ʉɧɢɝɢ: ɮɿɡɢɱɧɚ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɚ
ɦɟɞɢɰɢɧɚ ɦɟɞɢɰɢɧɚ – ɰɟ ɩɟɪɜɢɧɧɚ ɦɟɞɢɱɧɚ ɫɩɟɰɿɚɥɶɧɿɫɬɶ, ɹɤɚ ɜɿɞɩɨɜɿɞɚɽ ɡɚ ɩɪɨɮɿɥɚɤɬɢɤɭ, ɦɟɞɢɱɧɭ
ɞɿɚɝɧɨɫɬɢɤɭ, ɥɿɤɭɜɚɧɧɹ ɬɚ ɭɩɪɚɜɥɿɧɧɹ ɪɟɚɛɿɥɿɬɚɰɿɽɸ ɨɫɿɛ ɭɫɿɯ ɜɿɤɨɜɢɯ ɝɪɭɩ ɡɿ ɫɬɚɧɚɦɢ
ɡɞɨɪɨɜ’ɹ, ɳɨ ɩɪɢɡɜɨɞɹɬɶ ɞɨ ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɬɚ ʀɯ ɤɨɦɨɪɛɿɞɧɢɯ ɫɬɚɧɿɜ ɬɚ
ɩɪɢɞɿɥɹɽ ɨɫɨɛɥɢɜɭ ɭɜɚɝɭ ɩɨɪɭɲɟɧɧɹɦ ɿ ɨɛɦɟɠɟɧɧɹɦ ɚɤɬɢɜɧɨɫɬɿ ɡ ɦɟɬɨɸ ɫɩɪɢɹɧɧɹ ʀʀ
ɮɿɡɢɱɧɨɦɭ ɿ ɤɨɝɧɿɬɢɜɧɨɦɭ ɮɭɧɤɰɿɨɧɭɜɚɧɧɸ (ɜɤɥɸɱɚɸɱɢ ɩɨɜɟɞɿɧɤɭ), ɭɱɚɫɬɿ (ɜɤɥɸɱɚɸɱɢ
ɹɤɿɫɬɶ ɠɢɬɬɹ) ɿ ɦɨɞɢɮɿɤɚɰɿʀ ɨɫɨɛɢɫɬɢɯ ɮɚɤɬɨɪɿɜ ɬɚ ɮɚɤɬɨɪɿɜ ɫɟɪɟɞɨɜɢɳɚ.
Ʌɿɤɚɪ ɮɿɡɢɱɧɨʀ ɬɚ Ʌɿɤɚɪ ɡɚ ɫɩɟɰɿɚɥɶɧɿɫɬɸ ɮɿɡɢɱɧɚ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɚ ɦɟɞɢɰɢɧɚ; ɫɩɟɰɿɚɥɿɫɬ ɡ ɮɿɡɢɱɧɨʀ ɬɚ
ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ; ɬɚɤ ɫɚɦɨ, ɹɤ ɿ Ɏɿɡɿɚɬɪ.
Ɏɿɡɢɱɧɚ ɦɟɞɢɰɢɧɚ ɑɚɫɬɢɧɚ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ, ɳɨ ɡɚɣɦɚɽɬɶɫɹ ɡɚɫɬɨɫɭɜɚɧɧɹɦ ɮɿɡɢɱɧɢɯ
ɦɨɞɚɥɶɧɨɫɬɟɣ, ɜɤɥɸɱɚɸɱɢ ɞɿɚɝɧɨɫɬɢɱɧɿ ɱɢ ɬɟɪɚɩɟɜɬɢɱɧɿ ɦɟɬɨɞɢ; ɰɟ ɜɤɥɸɱɚɽ ɬɟɪɚɩɟɜɬɢɱɧɿ
ɜɩɪɚɜɢ, ɨɫɤɿɥɶɤɢ ɜɨɧɢ ɡɚɫɧɨɜɚɧɿ ɧɚ ɮɿɡɢɱɧɢɯ ɡɭɫɢɥɥɹɯ.
Ɏɿɡɢɱɧɚ ɦɟɞɢɰɢɧɚ ɬɚ ɋɬɚɪɟ ɜɢɡɧɚɱɟɧɧɹ ɫɩɟɰɿɚɥɶɧɨɫɬɿ, ɹɤɟ ɜɫɟ ɳɟ ɡɛɟɪɿɝɚɽɬɶɫɹ ɜ ɞɟɹɤɢɯ ɤɪɚʀɧɚɯ ɡɚ ɦɟɠɚɦɢ
ɪɟɚɛɿɥɿɬɚɰɿɹ ȯɜɪɨɩɢ (ɡɨɤɪɟɦɚ ɋɒȺ, ɚɥɟ ɧɟ ɬɿɥɶɤɢ). Ɂɚɪɚɡ ɡɚɦɿɧɸɽɬɶɫɹ ɧɚ «Ɏɿɡɢɱɧɚ ɬɚ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɚ
Ɇɟɞɢɰɢɧɚ».
Ɏɿɡɢɱɧɿ ɦɨɞɚɥɶɧɨɫɬɿ ȱɧɫɬɪɭɦɟɧɬɢ, ɳɨ ɜɢɤɨɪɢɫɬɨɜɭɸɬɶɫɹ ɞɥɹ ɡɚɫɬɨɫɭɜɚɧɧɹ ɮɿɡɢɱɧɢɯ ɡɨɜɧɿɲɧɿɯ ɬɟɪɚɩɟɜɬɢɱɧɢɯ
ɫɢɥ. ȱɧɨɞɿ ɬɚɤɨɠ ɧɚɡɢɜɚɸɬɶɫɹ Ɏɿɡɢɱɧɚ ɬɟɪɚɩɿɹ ɬɚ/ɚɛɨ Ɏɿɡɿɨɬɟɪɚɩɿɹ
Ɏɿɡɢɱɧɚ ɬɟɪɚɩɿɹ ɑɚɫɬɢɧɚ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ, ɹɤɚ ɡɚɣɦɚɽɬɶɫɹ ɡɚɫɬɨɫɭɜɚɧɧɹɦ ɮɿɡɢɱɧɢɯ
ɦɨɞɚɥɶɧɨɫɬɟɣ. ȱɧɨɞɿ ɬɚɤɨɠ ɧɚɡɢɜɚɽɬɶɫɹ ɮɿɡɿɨɬɟɪɚɩɿɽɸ.
Ɏɿɡɿɨɬɟɪɚɩɟɜɬ Ɏɚɯɿɜɟɰɶ ɪɟɚɛɿɥɿɬɚɰɿʀ ɜ ɝɚɥɭɡɿ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ’ɹ, ɹɤɢɣ ɩɪɚɤɬɢɤɭɽ ɮɿɡɿɨɬɟɪɚɩɿɸ. ɇɟ ɽ
(ɮɿɡɢɱɧɢɣ ɬɟɪɚɩɟɜɬ) ɥɿɤɚɪɟɦ. ɇɟ ɩɥɭɬɚɬɢ ɡ ɥɿɤɚɪɟɦ Ɏɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ.
Ɏɿɡɿɨɬɟɪɚɩɿɹ Ɉɞɧɚ ɡ ɨɛɥɚɫɬɟɣ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ ɚɛɨ ɦɨɞɚɥɶɧɨɫɬɟɣ ɜɬɪɭɱɚɧɧɹ, ɹɤɚ
ɡɚɡɜɢɱɚɣ ɩɪɚɤɬɢɤɭɽɬɶɫɹ ɮɿɡɢɱɧɢɦɢ ɬɟɪɚɩɟɜɬɚɦɢ. ȱɧɨɞɿ ɬɚɤɨɠ ɧɚɡɢɜɚɸɬɶ ɮɿɡɢɱɧɨɸ
ɬɟɪɚɩɿɽɸ. ɍ ɞɟɹɤɢɯ ɜɢɩɚɞɤɚɯ ɞɟɹɤɿ ɡ ɰɢɯ ɜɬɪɭɱɚɧɶ ɡɚɫɬɨɫɨɜɭɸɬɶɫɹ ɥɿɤɚɪɹɦɢ ɎɊɆ.
ɉɿɞɝɨɫɬɪɚ ɮɚɡɚ ȼɿɞɧɨɫɢɬɶɫɹ ɞɨ ɩɟɪɿɨɞɭ ɩɿɫɥɹ ɝɨɫɬɪɨʀ ɮɚɡɢ ɩɿɫɥɹ ɪɚɩɬɨɜɨɝɨ ɧɚɫɬɚɧɧɹ ɫɬɚɧɭ, ɤɨɥɢ ɩɚɰɿɽɧɬ
ɦɟɞɢɱɧɨ ɽ ɞɨɫɢɬɶ ɫɬɚɛɿɥɶɧɢɦ; ɬɚɤɨɠ ɩɚɰɿɽɧɬɚɦ ɡ ɩɟɪɿɨɞɢɱɧɢɦɢ, ɩɪɨɝɪɟɫɭɸɱɢɦɢ ɚɛɨ
ɫɬɚɛɿɥɶɧɢɦɢ ɫɬɚɧɚɦɢ ɦɨɠɥɢɜɨ ɞɨɩɨɦɨɝɬɢ ɭ ɮɚɡɚɯ ɡɦɿɧɢ ɩɨɬɪɟɛ; ɜ ɰɿɣ ɮɚɡɿ ɩɪɨɞɨɜɠɭɽɬɶɫɹ
ɪɨɡɜɢɬɨɤ ɩɚɰɿɽɧɬɚ.
ɉɿɫɥɹɞɢɩɥɨɦɧɢɣ Ɂɚɡɜɢɱɚɣ, ɛɭɞɶ-ɹɤɢɣ ɧɚɜɱɚɥɶɧɢɣ ɤɭɪɫ, ɩɪɢɫɜɹɱɟɧɢɣ ɨɫɨɛɚɦ ɳɨ ɡɚɤɿɧɱɢɥɢ ɫɬɭɩɿɧɶ ɩɟɪɲɨɝɨ
ɪɿɜɧɹ. Ⱦɥɹ ɥɿɤɚɪɿɜ ɰɟ ɬɚɤɨɠ ɜɤɥɸɱɚɽ ɧɚɜɱɚɧɧɹ ɬɚ ɨɫɜɿɬɭ ɞɥɹ ɡɞɨɛɭɬɬɹ ɡɧɚɧɶ ɬɚ ɧɚɜɢɱɨɤ ɭ
ɫɩɟɰɿɚɥɿɡɨɜɚɧɿɣ ɝɚɥɭɡɿ ɦɟɞɢɰɢɧɢ.
ɉɨɬɟɧɰɿɚɥ ɜɿɞɧɨɜɥɟɧɧɹ ɑɟɪɟɡ ɩɪɨɰɟɫɢ ɪɟɩɚɪɚɰɿʀ ɜɨɧɢ ɬɚɤɨɠ ɩɨɜ'ɹɡɚɧɿ ɡ ɨɫɨɛɢɫɬɢɦɢ ɮɚɤɬɨɪɚɦɢ ɬɚ ɮɚɤɬɨɪɚɦɢ
ɫɟɪɟɞɨɜɢɳɚ. Ʌɿɤɚɪɿ ɎɊɆ ɩɪɨɩɨɧɭɸɬɶ ɬɚ ɩɥɚɧɭɸɬɶ ɪɟɚɛɿɥɿɬɚɰɿɸ, ɡɚ ɧɚɹɜɧɨɫɬɿ ɩɨɬɟɧɰɿɚɥɭ
ɜɿɞɧɨɜɥɟɧɧɹ (ɮɭɧɤɰɿɨɧɚɥɶɧɢɣ ɩɪɨɝɧɨɡ).
Ⱦɨɤɥɿɧɿɱɧɿ ɞɨɫɥɿɞɠɟɧɧɹ ȼɤɥɸɱɚɸɬɶ ɟɤɫɩɟɪɢɦɟɧɬɢ ɜ ɤɥɿɬɢɧɚɯ ɬɚ ɧɚ ɬɜɚɪɢɧɧɢɯ ɦɨɞɟɥɹɯ, ɳɨ ɧɟ ɽ ɥɸɞɶɦɢ.
ɉɪɟɚɛɿɥɿɬɚɰɿɹ ɇɚɜɱɚɥɶɧɚ ɩɪɨɝɪɚɦɚ ɬɚ ɞɨɨɩɟɪɚɰɿɣɧɿ ɮɿɡɢɱɧɟ ɬɚ/ɚɛɨ ɩɫɢɯɨɥɨɝɿɱɧɟ ɤɨɧɞɢɰɿɨɧɭɜɚɧɧɹ, ɳɨ
ɩɿɞɜɢɳɭɽ ɮɭɧɤɰɿɨɧɚɥɶɧɿ ɬɚ ɩɫɢɯɿɱɧɿ ɪɨɡɭɦɨɜɿ ɡɞɿɛɧɨɫɬɿ, ɫɩɪɹɦɨɜɚɧɿ ɧɚ ɩɨɥɿɩɲɟɧɧɹ
ɩɿɫɥɹɨɩɟɪɚɰɿɣɧɢɯ ɮɭɧɤɰɿɨɧɚɥɶɧɢɯ ɪɟɡɭɥɶɬɚɬɿɜ.
ɉɟɪɜɢɧɧɟ ɞɨɫɥɿɞɠɟɧɧɹ Ɉɪɢɝɿɧɚɥɶɧɟ ɞɨɫɥɿɞɠɟɧɧɹ ɡ ɩɟɪɲɢɯ ɪɭɤ; ɩɭɛɥɿɤɚɰɿɸ ɣɨɝɨ ɪɟɡɭɥɶɬɚɬɿɜ ɛɭɞɟ ɧɚɩɢɫɚɧɨ
ɨɫɨɛɨɸ(ɚɦɢ), ɹɤɚ(ɿ) ɛɪɚɥɚ(ɢ) ɭɱɚɫɬɶ ɜ ɞɨɫɥɿɞɠɟɧɧɿ.
ȼɬɪɭɱɚɧɧɹ ɮɿɡɢɱɧɨʀ ɬɚ Ȼɭɞɶ ɹɤɿ ɞɿɚɝɧɨɫɬɢɱɧɿ ɚɛɨ ɬɟɪɚɩɟɜɬɢɱɧɿ ɞɿʀ ɚɛɨ ɩɪɨɰɟɞɭɪɢ, ɩɨɜ'ɹɡɚɧɿ ɡɿ ɫɮɟɪɨɸ
ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ ɤɨɦɩɟɬɟɧɬɧɨɫɬɟɣ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ
PsycINFO Ȼɚɡɚ ɞɚɧɢɯ ɪɟɡɸɦɟ ɥɿɬɟɪɚɬɭɪɢ ɜ ɫɮɟɪɿ ɩɫɢɯɨɥɨɝɿʀ.
Ɋɟɚɛɿɥɿɬɚɰɿɣɧɢɣ ɰɢɤɥ ɉɨɜɬɨɪɸɜɚɧɢɣ ɩɪɨɰɟɫ ɨɰɿɧɸɜɚɧɧɹ, ɩɪɢɡɧɚɱɟɧɧɹ, ɜɬɪɭɱɚɧɧɹ ɬɚ ɨɰɿɧɤɢ ɪɟɚɛɿɥɿɬɚɰɿɣɧɢɯ
ɩɨɬɪɟɛ ɬɚ ɰɿɥɟɣ ɥɸɞɢɧɢ.

22 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Ãëîñàð³é (ïðîäîâæåííÿ)

Ɋɟɚɛɿɥɿɬɚɰɿɹ ɇɚɛɿɪ ɡɚɯɨɞɿɜ, ɹɤɿ ɞɨɩɨɦɚɝɚɸɬɶ ɨɫɨɛɚɦ, ɹɤɿ ɡɚɡɧɚɸɬɶ ɚɛɨ ɦɨɠɭɬɶ ɡɚɡɧɚɬɢ ɨɛɦɟɠɟɧɶ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ, ɞɨɫɹɝɬɢ ɬɚ ɩɿɞɬɪɢɦɭɜɚɬɢ ɨɩɬɢɦɚɥɶɧɟ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɩɪɢ ɜɡɚɽɦɨɞɿʀ ɡɿ
ɫɜɨʀɦɢ ɫɟɪɟɞɨɜɢɳɚɦɢ.
Ɋɟɚɛɿɥɿɬɚɰɿɣɧɚ ɦɟɞɢɰɢɧɚ ɇɚɡɜɚ, ɩɪɢɫɜɨɽɧɚ ɫɩɟɰɿɚɥɶɧɨɫɬɿ ɜ ɞɟɹɤɢɯ ɤɪɚʀɧɚɯ ȯɜɪɨɩɢ, ɚɥɟ ɧɟ ɜɢɡɧɚɧɚ ɧɚ ɦɿɠɧɚɪɨɞɧɨɦɭ
ɪɿɜɧɿ. Ɋɨɡɝɥɹɞɚɽɬɶɫɹ ɞɟɹɤɢɦɢ, ɹɤ ɱɚɫɬɢɧɚ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ, ɹɤɚ
ɡɚɣɦɚɽɬɶɫɹ ɪɟɚɛɿɥɿɬɚɰɿɽɸ, ɡɚ ɜɢɧɹɬɤɨɦ ɮɿɡɢɱɧɢɯ ɦɨɞɚɥɶɧɨɫɬɟɣ ɬɚ/ɚɛɨ ɮɿɡɢɱɧɨʀ ɬɟɪɚɩɿʀ:
ɨɫɤɿɥɶɤɢ ɪɟɚɛɿɥɿɬɚɰɿɹ ɽ ɰɿɥɿɫɧɨɸ ɿ ɜɤɥɸɱɚɽ ɜ ɫɟɛɟ ɜɫɿ ɜɬɪɭɱɚɧɧɹ, ɳɨ ɛɚɡɭɸɬɶɫɹ ɧɚ ɞɨɤɚɡɚɯ,
ɹɤɿ ɞɨɡɜɨɥɹɸɬɶ ɪɟɚɛɿɥɿɬɭɜɚɬɢ ɥɸɞɟɣ, ɹɤɿ ɡɚɡɧɚɥɢ ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ, ɬɨɠ ɧɟ
ɦɨɠɥɢɜɨ ɜɢɤɥɸɱɚɬɢ ɮɿɡɢɱɧɿ ɦɨɞɚɥɶɧɨɫɬɿ, ɳɨ ɦɚɸɬɶ ɞɨɤɚɡɨɜɭ ɛɚɡɭ.
Ɋɟɚɛɿɥɿɬɚɰɿɣɧɚ ɩɪɨɝɪɚɦɚ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɚ ɩɪɨɝɪɚɦɚ – ɰɟ ɯɪɨɧɨɥɨɝɿɱɧɢɣ ɩɟɪɟɥɿɤ ɞɿɚɝɧɨɫɬɢɱɧɢɯ ɿ ɬɟɪɚɩɟɜɬɢɱɧɢɯ ɞɿɣ ɬɚ
ɡɚɯɨɞɿɜ, ɳɨ ɧɟɨɛɯɿɞɧɿ ɞɥɹ ɪɟɚɝɭɜɚɧɧɹ ɧɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɿ ɩɨɬɪɟɛɢ ɬɚ ɰɿɥɿ ɩɚɰɿɽɧɬɚ; ɰɟ ɦɨɠɟ
ɛɭɬɢ ɞɥɹ ɤɨɧɤɪɟɬɧɨʀ ɮɚɡɢ ɚɛɨ ɩɪɨɬɹɝɨɦ ɤɨɧɬɢɧɭɭɦɭ ɞɨɩɨɦɨɝɢ.
Ɋɟɚɛɿɥɿɬɚɰɿɣɧɿ ɩɨɫɥɭɝɢ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɿ ɩɨɫɥɭɝɢ – ɰɟ ɨɫɨɛɢɫɬɿ ɬɚ ɧɟɨɫɨɛɢɫɬɿ ɧɟɦɚɬɟɪɿɚɥɶɧɿ ɩɪɨɞɭɤɬɢ, ɳɨ
ɩɪɨɩɨɧɭɸɬɶɫɹ ɨɫɨɛɚɦ ɡɿ ɫɬɚɧɨɦ ɡɞɨɪɨɜ'ɹ, ɹɤɿ ɡɚɡɧɚɸɬɶ ɚɛɨ ɦɨɠɭɬɶ ɡɚɡɧɚɬɢ ɨɛɦɟɠɟɧɶ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ, ɚɛɨ ʀɯ ɧɟɨɮɿɰɿɣɧɢɦ ɞɨɝɥɹɞɚɱɚɦ ɜ ɪɚɦɤɚɯ ɨɪɝɚɧɿɡɨɜɚɧɢɯ ɡɚɤɥɚɞɿɜ, ɭ
ɜɡɚɽɦɨɞɿʀ ɦɿɠ ɧɚɞɚɜɚɱɟɦ ɬɚ ɨɫɨɛɨɸ, ɫɩɪɹɦɨɜɚɧɿ ɧɚ ɿɧɞɢɜɿɞɭɚɥɶɧɿ ɮɭɧɤɰɿɨɧɚɥɶɧɿ ɩɨɬɪɟɛɢ,
ɹɤɿ ɧɚɰɿɥɟɧɿ ɧɚ ɭɦɨɠɥɢɜɥɟɧɧɹ ɨɫɿɛ ɞɨɫɹɝɧɭɬɢ ɬɚ ɩɿɞɬɪɢɦɭɜɚɬɢ ɨɩɬɢɦɚɥɶɧɟ
ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ, ɡɜɚɠɚɸɱɢ ɧɚ ɿɧɬɟɝɪɚɰɿɸ ɿɧɲɢɯ ɩɨɫɥɭɝ, ɳɨ ɫɩɪɹɦɨɜɚɧɿ ɧɚ ɩɨɬɪɟɛɢ
ɿɧɞɢɜɿɞɭɭɦɭ, ɜɤɥɸɱɚɸɱɢ ɩɨɫɥɭɝɢ ɡ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ’ɹ, ɫɨɰɿɚɥɶɧɿ, ɬɪɭɞɨɜɿ ɬɚ ɨɫɜɿɬɧɿ
ɩɨɫɥɭɝɢ, ɬɚ ɧɚɞɚɸɬɶɫɹ ɮɚɯɿɜɰɹɦɢ ɪɟɚɛɿɥɿɬɚɰɿʀ, ɿɧɲɢɦɢ ɮɚɯɿɜɰɹɦɢ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ ɚɛɨ
ɧɚɥɟɠɧɢɦ ɱɢɧɨɦ ɧɚɜɱɟɧɢɦɢ ɩɪɚɰɿɜɧɢɤɚɦɢ ɦɿɫɰɟɜɢɯ ɝɪɨɦɚɞ.
ɉɪɨɰɟɫɢ ɪɟɩɚɪɚɰɿʀ Ɂɞɚɬɧɿɫɬɶ ɨɪɝɚɧɿɡɦɭ ɜɿɞɧɨɜɢɬɢɫɶ ɩɿɫɥɹ ɯɜɨɪɨɛɢ, ɪɨɡɥɚɞɿɜ ɚɛɨ ɬɪɚɜɦ. ȼɨɧɢ ɜ ɨɫɧɨɜɧɨɦɭ
ɩɨɜ'ɹɡɚɧɿ ɡ ɤɿɥɶɤɿɫɬɸ ɬɚ ɿɫɬɨɪɿɽɸ ɪɨɡɜɢɬɤɭ ɡɚɯɜɨɪɸɜɚɧɶ ɬɚ ɩɨɪɭɲɟɧɶ.
Ɋɨɛɨɬɨɬɟɯɧɿɤɚ Ɇɟɞɢɱɧɚ ɞɢɫɰɢɩɥɿɧɚ, ɡɚ ɞɨɩɨɦɨɝɨɸ ɹɤɨʀ, ɜɢɤɨɪɢɫɬɨɜɭɸɱɢ ɪɨɡɭɦɧɿ ɬɟɯɧɨɥɨɝɿɱɧɿ ɩɪɢɫɬɪɨʀ,
ɹɤɿ ɜɡɚɽɦɨɞɿɸɬɶ ɡ ɫɭɛ’ɽɤɬɚɦɢ ɬɚ/ɚɛɨ ʀɯ ɫɟɪɟɞɨɜɢɳɟɦ, ɿɧɞɢɜɿɞɭɭɦɚɦɢ, ɞɨɩɨɦɚɝɚɸɬɶ
ɬɪɟɧɭɜɚɬɢ ɿ ɜɿɞɧɨɜɥɸɜɚɬɢ ɜɬɪɚɱɟɧɿ ɮɿɡɢɱɧɿ ɮɭɧɤɰɿʀ.
ɇɚɭɤɨɜɢɣ ɿɧɞɟɤɫ ɰɢɬɭɜɚɧɧɹ ɐɟ ɿɧɞɟɤɫ ɰɢɬɭɜɚɧɧɹ, ɹɤɢɣ ɫɩɨɱɚɬɤɭ ɛɭɜ ɪɨɡɪɨɛɥɟɧɢɣ Institute for Scientific Information
(SCI) (ISI), ɨɯɨɩɥɸɽ ɩɨɧɚɞ 8500 ɜɿɞɨɦɢɯ ɬɚ ɜɢɞɚɬɧɢɯ ɠɭɪɧɚɥɿɜ ɭ 150 ɞɢɫɰɢɩɥɿɧɚɯ ɡ 1900 ɪɨɤɭ
ɞɨɬɟɩɟɪ.
SCImago ɐɟ ɤɥɚɫɢɮɿɤɚɬɨɪ ɠɭɪɧɚɥɿɜ (ɿɧɞɢɤɚɬɨɪ SJR), ɳɨ ɜɢɦɿɪɸɽ ɧɚɭɤɨɜɢɣ ɜɩɥɢɜ ɧɚɭɤɨɜɢɯ
ɠɭɪɧɚɥɿɜ, ɳɨ ɜɪɚɯɨɜɭɽ ɹɤ ɤɿɥɶɤɿɫɬɶ ɰɢɬɭɜɚɧɶ, ɨɬɪɢɦɚɧɢɯ ɠɭɪɧɚɥɨɦ, ɬɚɤ ɿ ɜɚɠɥɢɜɿɫɬɶ ɚɛɨ
ɩɪɟɫɬɢɠ ɠɭɪɧɚɥɿɜ, ɡ ɹɤɢɯ ɜɢɯɨɞɢɬɶ ɰɢɬɭɜɚɧɧɹ.
Scopus Ȼɿɛɥɿɨɝɪɚɮɿɱɧɚ ɛɚɡɚ ɞɚɧɢɯ ɡ ɪɟɮɟɪɚɬɚɦɢ ɬɚ ɰɢɬɭɜɚɧɧɹɦɢ ɫɬɚɬɟɣ ɚɤɚɞɟɦɿɱɧɢɯ ɠɭɪɧɚɥɿɜ, ɳɨ
ɨɯɨɩɥɸɸɬɶ ɦɚɣɠɟ 22 000 ɧɚɣɦɟɧɭɜɚɧɶ ɡ ɩɨɧɚɞ 5000 ɜɢɞɚɜɧɢɰɬɜ, ɡ ɹɤɢɯ 20 000 ɽ
ɪɟɰɟɧɡɨɜɚɧɢɦɢ ɠɭɪɧɚɥɚɦɢ ɡ ɧɚɭɤɨɜɢɯ, ɬɟɯɧɿɱɧɢɯ, ɦɟɞɢɱɧɢɯ ɬɚ ɫɨɰɿɚɥɶɧɢɯ ɧɚɭɤ
(ɜɤɥɸɱɚɸɱɢ ɦɢɫɬɟɰɬɜɨ ɬɚ ɝɭɦɚɧɿɬɚɪɧɿ ɧɚɭɤɢ);
ȼɬɨɪɢɧɧɿ ɞɨɫɥɿɞɠɟɧɧɹ ɐɟ ɚɧɚɥɿɡ ɬɚ ɿɧɬɟɪɩɪɟɬɚɰɿɹ ɩɭɛɥɿɤɚɰɿɣ ɩɟɪɜɢɧɧɢɯ ɞɨɫɥɿɞɠɟɧɶ ɭ ɝɚɥɭɡɿ ɡ ɫɩɟɰɢɮɿɱɧɨɸ
ɦɟɬɨɞɨɥɨɝɿɽɸ. Ʉɨɤɪɚɧɿɜɫɶɤɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɚ ɫɮɟɪɚ ɽ ɩɪɢɤɥɚɞɨɦ ɜɬɨɪɢɧɧɢɯ ɞɨɫɥɿɞɠɟɧɶ.
Sedbase ɐɟ ɛɚɡɚ ɞɚɧɢɯ ɩɨɛɿɱɧɢɯ ɞɿɣ ɥɿɤɿɜ
Ʌɿɤɚɪ ɋɉȺ Ʌɿɤɚɪ-ɟɤɫɩɟɪɬ ɡ ɩɪɢɪɨɞɧɨʀ ɦɿɧɟɪɚɥɶɧɨʀ ɜɨɞɢ, ʀʀ ɜɩɥɢɜɭ ɧɚ ɨɪɝɚɧɿɡɦ ɬɚ ɭɩɪɚɜɥɿɧɧɹ, ɹɤɢɣ,
ɡɚɡɜɢɱɚɣ, ɩɪɚɰɸɽ ɜ Ɍɟɪɦɚɥɶɧɢɯ ɡɚɤɥɚɞɚɯ ɚɛɨ ɡɚɤɥɚɞɚɯ Ȼɚɥɶɧɟɨɬɟɪɚɩɿʀ; ɩɪɢ ɨɬɪɢɦɚɧɧɿ
ɤɜɚɥɿɮɿɤɚɰɿʀ (ɧɚɛɭɬɬɹ ɜ ɞɟɹɤɢɯ ɽɜɪɨɩɟɣɫɶɤɢɯ ɤɪɚʀɧɚɯ ɩɟɜɧɨʀ ɫɩɟɰɿɚɥɶɧɨɫɬɿ ɚɛɨ
ɤɨɦɩɟɬɟɧɬɧɨɫɬɿ), ɥɿɤɚɪɿ ɋɉȺ ɧɚɡɢɜɚɸɬɶɫɹ ɥɿɤɚɪɹɦɢ ɦɟɞɢɱɧɨʀ ɝɿɞɪɨɥɨɝɿʀ (ɝɿɞɪɨɥɨɝɢ) ɚɛɨ
ɥɿɤɚɪɹɦɢ ɛɚɥɶɧɟɨɥɨɝɿʀ (ɛɚɥɶɧɟɨɥɨɝɢ).
ʈɪɭɧɬɨɜɚɧɢɣ ɧɚ ɤɨɦɚɧɞɿ Ȼɭɞɶ-ɹɤɟ ɜɬɪɭɱɚɧɧɹ ɜ ɨɯɨɪɨɧɿ ɡɞɨɪɨɜ’ɹ, ɹɤɟ ɛɭɥɨ ɧɚɞɚɧɨ, ɹɤ ɪɟɡɭɥɶɬɚɬ ɩɪɨɰɟɫɭ ɫɩɿɥɶɧɨɝɨ
ɩɪɢɣɧɹɬɬɹ ɪɿɲɟɧɶ ɭ ɦɭɥɶɬɢ-ɩɪɨɮɟɫɿɣɧɿɣ ɤɨɦɚɧɞɿ.
Ɍɟɪɦɚɥɶɧɢɣ ɡɚɤɥɚɞ Ɇɿɫɰɟ ɩɪɨɜɟɞɟɧɧɹ ɥɿɤɭɜɚɥɶɧɢɯ ɩɪɨɰɟɞɭɪ ɡɚ ɞɨɩɨɦɨɝɨɸ ɩɪɢɪɨɞɧɨʀ ɦɿɧɟɪɚɥɶɧɨʀ ɜɨɞɢ.
Ɍɪɚɧɫɥɹɰɿɣɧɿ ɦɟɞɢɱɧɿ Ⱦɨɫɥɿɞɠɟɧɧɹ ɬɚ ɪɨɡɪɨɛɤɢ, ɹɤɿ ɩɪɨɩɨɧɭɸɬɶ ɩɟɪɟɯɿɞ ɜɿɞ ɮɭɧɞɚɦɟɧɬɚɥɶɧɢɯ ɞɨɫɥɿɞɠɟɧɶ ɞɨ
ɞɨɫɥɿɞɠɟɧɧɹ ɤɨɦɟɪɰɿɣɧɨ ɠɢɬɬɽɡɞɚɬɧɢɯ ɡɚɫɬɨɫɭɜɚɧɶ (ɜɿɞ «ɥɚɜɢ ɞɨ ɥɿɠɤɚ»)
ɋɨɪɬɭɜɚɧɧɹ ȼɢɛɿɪ ɬɚ ɩɪɢɡɧɚɱɟɧɧɹ ɜɬɪɭɱɚɧɶ ɩɚɰɿɽɧɬɚɦ ɡɚ ɫɢɫɬɟɦɨɸ ɩɪɿɨɪɢɬɟɬɿɜ, ɜɢɯɨɞɹɱɢ ɡ ɩɨɬɪɟɛɢ
ɩɚɰɿɽɧɬɿɜ ɭ ɞɨɩɨɦɨɡɿ, ɳɨ ɩɨɛɭɞɨɜɚɧɚ ɡ ɦɟɬɨɸ ɦɚɤɫɢɦɿɡɚɰɿʀ ɪɟɡɭɥɶɬɚɬɭ.
Ʉɨɧɜɟɧɰɿɹ ɈɈɇ ɡ ɩɪɚɜ ȼɩɪɨɜɚɞɠɟɧɧɹ Ɂɚɝɚɥɶɧɨʀ ɞɟɤɥɚɪɚɰɿʀ.
ɥɸɞɢɧɢ 2005
ɍɧɿɜɟɪɫɚɥɶɧɚ Ɂɚɝɚɥɶɧɚ ɉɪɢɯɢɥɶɧɿɫɬɶ ɭɪɹɞɿɜ ɩɪɨɝɪɟɫɢɜɧɢɦ ɡɚɯɨɞɚɦ ɞɥɹ ɡɚɛɟɡɩɟɱɟɧɧɹ ɡɚɝɚɥɶɧɨɝɨ ɬɚ ɟɮɟɤɬɢɜɧɨɝɨ
ɞɟɤɥɚɪɚɰɿɹ ɩɪɚɜ ɥɸɞɢɧɢ ɜɢɡɧɚɧɧɹ ɬɚ ɞɨɬɪɢɦɚɧɧɹ ɩɪɚɜ ɥɸɞɢɧɢ.
ɈɈɇ
Ⱦɨɞɢɩɥɨɦɧɢɣ ȼɯɿɞɧɢɣ ɪɿɜɟɧɶ ɫɬɭɞɟɧɬɿɜ ɭɧɿɜɟɪɫɢɬɟɬɭ. ȼɿɧ ɜɤɥɸɱɚɽ ɜ ɫɟɛɟ ɜɫɿ ɚɤɚɞɟɦɿɱɧɿ ɩɪɨɝɪɚɦɢ ɞɨ
ɪɿɜɧɹ ɛɚɤɚɥɚɜɪɫɶɤɨɝɨ ɫɬɭɩɟɧɹ, ɚɛɨ, ɭ ɜɢɩɚɞɤɭ ɫɬɭɞɟɧɬɿɜ-ɦɟɞɢɤɿɜ, ɦɚɝɿɫɬɟɪɫɶɤɨɝɨ ɫɬɭɩɟɧɹ.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 23
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Ãëîñàð³é (ïðîäîâæåííÿ)

ȼɿɪɬɭɚɥɶɧɚ ɪɟɚɥɶɧɿɫɬɶ
ɉɪɨɮɟɫɿɣɧɚ ɪɟɚɛɿɥɿɬɚɰɿɹ
Ʌɚɛɨɪɚɬɨɪɿɹ ɯɨɞɶɛɢ
«Ƚɥɨɛɚɥɶɧɢɣ ɩɥɚɧ ɞɿɣ ɳɨɞɨ
ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ»
ȼɈɈɁ
Ⱦɢɫɰɢɩɥɿɧɚ, ɡɚɫɧɨɜɚɧɚ ɧɚ ɜɢɤɨɪɢɫɬɚɧɧɿ ɤɨɦɩ'ɸɬɟɪɿɜ ɬɚ ɿɧɲɢɯ ɩɪɢɫɬɪɨʀɜ, ɦɟɬɨɸ ɹɤɢɯ ɽ
ɫɬɜɨɪɟɧɧɹ ɜɢɝɥɹɞɭ ɪɟɚɥɶɧɨɫɬɿ, ɳɨ ɞɨɡɜɨɥɹɽ ɤɨɪɢɫɬɭɜɚɱɟɜɿ ɦɚɬɢ ɜɿɞɱɭɬɬɹ ɩɪɢɫɭɬɧɨɫɬɿ ɭ ɧɿɣ.
ɉɪɨɰɟɫ, ɹɤɢɣ ɭɦɨɠɥɢɜɥɸɽ ɨɫɨɛɚɦ ɡ ɮɭɧɤɰɿɨɧɚɥɶɧɢɦɢ, ɩɫɢɯɨɥɨɝɿɱɧɢɦɢ, ɪɨɡɜɢɬɤɨɜɢɦɢ,
ɤɨɝɧɿɬɢɜɧɢɦɢ ɬɚ ɟɦɨɰɿɣɧɢɦɢ ɩɨɪɭɲɟɧɧɹɦɢ, ɚɛɨ ɨɛɦɟɠɟɧɧɹɦɢ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ,
ɩɨɜ’ɹɡɚɧɢɦɢ ɡɿ ɡɞɨɪɨɜ'ɹɦ, ɩɨɞɨɥɚɬɢ ɛɚɪ’ɽɪɢ ɞɨɫɬɭɩɭ, ɩɿɞɬɪɢɦɚɧɧɹ ɚɛɨ ɩɨɜɟɪɧɟɧɧɹ ɧɚ
ɨɩɥɚɱɭɜɚɧɭ ɪɨɛɨɬɭ ɱɢ ɿɧɲɟ ɤɨɪɢɫɧɟ ɡɚɧɹɬɬɹ.
ɋɢɫɬɟɦɚ ɜɢɦɿɪɸɜɚɧɧɹ, ɹɤɚ ɞɨɡɜɨɥɹɽ ɩɪɨɜɨɞɢɬɢ ɦɨɧɿɬɨɪɢɧɝ ɩɿɞ ɱɚɫ ɩɟɪɟɫɭɜɚɧɧɹ, ɡɛɢɪɚɸɱɢ
ɿɧɮɨɪɦɚɰɿɸ ɩɪɨ ɜɫɿ ɣɨɝɨ ɚɫɩɟɤɬɢ ɬɚ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ.
2014-2021 ɪɪ. ȱɧɿɰɿɚɬɢɜɚ «Ʉɪɚɳɟ ɡɞɨɪɨɜ'ɹ ɞɥɹ ɜɫɿɯ ɥɸɞɟɣ ɡ ɨɛɦɟɠɟɧɧɹɦɢ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ»

Êîìàíäà ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ – ì³æ-äèñöèïë³íàðíà ñï³âïðàöÿ: ñï³âïðàöÿ ì³æ

ìåäèöèíè ð³çíèìè ìåäè÷íèìè ñïåö³àëüíîñòÿìè (íàïð.
ë³êàð ÔÐÌ, òðàâìàòîëîã, íåâðîëîã, êàðä³îëîã òà/
Ó ë³òåðàòóð³, ùî ñòîñóºòüñÿ êîìàíäíî¿ ðîáîòè
àáî ³íø³).
òà ñï³âïðàö³ ó ðåàá³ë³òàö³¿, òåðì³íè ³íîä³ âèêîðèñ-
Òåðì³í “ìóëüòè-ïðîôåñ³éíà êîìàíäà” áóäå âè-
òîâóþòüñÿ ³íàêøå, í³æ ¿õ âèçíà÷åííÿ â íàóêîâ³é
êîðèñòîâóâàòèñÿ äëÿ ðåàá³ë³òàö³éíî¿ êîìàíäè, ùî
ë³òåðàòóð³ ç êîìàíäíèõ ìîäåëåé òà âçàºìî䳿 ì³æ
ñêëàäàºòüñÿ ç ð³çíèõ ôàõ³âö³â ðåàá³ë³òàö³¿, òåðì³í
÷ëåíàìè êîìàíäè. Òîìó òóò ïîòð³áíî ïîÿñíåííÿ
“ì³æ-äèñöèïë³íàðíå êîíñóëüòóâàííÿ” – äëÿ
òåðì³í³â.
ñï³âïðàö³ ë³êàð³â ÔÐÌ ç ³íøèìè ìåäè÷íèìè ñïå-
Ó ë³òåðàòóð³ ç ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäè-
ö³àë³ñòàìè ³ òåðì³í “ñï³ëüíà ðîáîòà êîìàíäè” – äëÿ
öèíè òåðì³íè ïåðåâàæíî âèêîðèñòîâóþòüñÿ äëÿ
êîìàíäè, ÿêà ïðàöþº â ì³æ-äèñöèïë³íàðíîìó,
îïèñó ïàðòíåð³â ïî ñï³âïðàö³, ÿê³ ïðàöþþòü ðàçîì
ìóëüòè-äèñöèïë³íàðíîìó àáî òðàíñ-äèñöèïë³íàð-
â êîìàíä³:
íîìó ïîðÿäêó â³äïîâ³äíî äî óìîâ ³ ïîòðåá.
– ìóëüòè-ïðîôåñ³éíà êîìàíäà: êîìàíäà, ùî ñêëà-
Êîìàíäîþ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöè-
äàºòüñÿ ç áàãàòüîõ ôàõ³âö³â ðåàá³ë³òàö³¿ (íàïð.
íè º ìóëüòè-ïðîôåñ³éíà êîìàíäà, ÿêà ïðàöþº
ë³êàð ÔÐÌ, ô³çè÷íèé òåðàïåâò, åðãîòåðàïåâò,
ñï³ëüíî ç ³íøèìè äèñöèïë³íàìè ï³ä êåð³âíèöòâîì
òåðàïåâò ìîâè òà ìîâëåííÿ, ìåäè÷í³ ñåñòðè òà/
ë³êàðÿ ÔÐÌ.
àáî ³íø³);

24 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Äîäàòîê 2

Ñïèñîê ó÷àñíèê³â

Ʉɟɪɿɜɧɢɣ ɤɨɦɿɬɟɬ

Negrini Stefano (ɋɟɤɰɿɹ ɎɊɆ ȯɋɆɋ) – Ʉɨɨɪɞɢɧɚɬɨɪ Clinical and Experimental Sciences Department, University of Brescia,
Brescia, ȱɬɚɥɿɹ
IRCCS Fondazione Don Gnocchi, Milan, ȱɬɚɥɿɹ
Moslavac Saša (ȯɄɎɊɆ) – ɋɟɤɪɟɬɚɪ Spinal Unit, Special Hospital for Medical Rehabilitation Varaždinske
Toplice
Referral Centre for Rehabilitation of Spinal Cord Injuries, Ministry of
Health, ɏɨɪɜɚɬɿɹ
Cantista Pedro (ȯɌɎɊɆ) Centro Hospitalar Universitário do Porto
ICBAS – Universidade do Porto, ɉɨɪɬɭɝɚɥɿɹ
Deveþerski Gordana (ȯɌɎɊɆ) Clinic for medical rehabilitation, Clinic center of Vojvodina
Medical faculty, University of Novi Sad, Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ
Gutenbrunner Christoph (ȯȺɊɆ) Department of Rehabilitation Medicine
Hannover Medical School, ɇɿɦɟɱɱɢɧɚ
Juocevicius Alvydas (ȯɄɎɊɆ) The Rehabilitation, Physical and Sports Medicine Center
Vilnius University Hospital Santaros Klinikos, Ʌɢɬɜɚ
Varela-Donoso Enrique (ɋɟɤɰɿɹ ɎɊɆ ȯɋɆɋ) Physical and Rehabilitation Medicine Department, Complutense
University, Madrid, ȱɫɩɚɧɿɹ
Ward Anthony B (ȯȺɊɆ) North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke on
Trent, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Staffordshire University, Stoke on Trent, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ

Ɋɟɞɚɤɬɨɪɢ
Negrini Stefano (ɋɟɤɰɿɹ ɎɊɆ ȯɋɆɋ) – Clinical and Experimental Sciences Department, University of Brescia,
Ʉɨɨɪɞɢɧɚɬɨɪ Brescia, ȱɬɚɥɿɹ
IRCCS Fondazione Don Gnocchi, Milan, ȱɬɚɥɿɹ
Moslavac Saša (ECPRM) – ɋɟɤɪɟɬɚɪ Spinal Unit, Special Hospital for Medical Rehabilitation Varaždinske
Toplice
Referral Centre for Rehabilitation of Spinal Cord Injuries, Ministry of
Health, ɏɨɪɜɚɬɿɹ
Cantista Pedro Centro Hospitalar Universitário do Porto
ICBAS – Universidade do Porto, ɉɨɪɬɭɝɚɥɿɹ
Ceravolo Maria Gabriella ɉɪɟɡɢɞɟɧɬ Ɋɚɞɢ ɎɊɆ ȯɋɆɋ
Department of Experimental and Clinical Medicine
Politecnica University of Marche, ȱɬɚɥɿɹ
Christodoulou Nicolas ɉɪɟɡɢɞɟɧɬ ɋɟɤɰɿʀ ɎɊɆ ȯɋɆɋ
European University Cyprus – Medical School
Limassol Centre of PRM, Ʉɿɩɪ
Delarque Alain ɉɪɟɡɢɞɟɧɬ ȯɜɪɨɩɟɣɫɶɤɨɝɨ Ɍɨɜɚɪɢɫɬɜɚ Ɏɿɡɢɱɧɨʀ ɬɚ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɨʀ
Ɇɟɞɢɰɢɧɢ (ȯɌɎɊɆ)
Pôle Médical Intersites de Médecine Physique et de Réadaptation-
Médecine du Sport
Institut Universitaire de Réadaptation (IUR)
Institut des Neurosciences de La Timone (INT), Marseille, Ɏɪɚɧɰɿɹ

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 25
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Ðåäàêòîðè (ïðîäîâæåííÿ)

Gutenbrunner Christoph Department of Rehabilitation Medicine

Hannover Medical School, ɇɿɦɟɱɱɢɧɚ
Kiekens Carlotte Physical and Rehabilitation Medicine
University Hospitals Leuven
Leuven, Ȼɟɥɶɝɿɹ
Varela-Donoso Enrique Physical and Rehabilitation Medicine Department
Complutense University, Madrid, ȱɫɩɚɧɿɹ
Ward Anthony B North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke on
Trent, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Staffordshire University, Stoke on Trent, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Zampolini Mauro Ƚɟɧɟɪɚɥɶɧɢɣ ɋɟɤɪɟɬɚɪ ɋɟɤɰɿʀ ɎɊɆ ȯɋɆɋ
Rehabilitation Network of Umbria Region
Foligno Hospital, Foligno (Perugia), ȱɬɚɥɿɹ

ɉɟɪɲɿ ɚɜɬɨɪɢ
Antunes Filipe Portuguese delegate and national manager of Ordem dos Médicos to UEMS Board and
Section, ɉɨɪɬɭɝɚɥɿɹ
Boldrini Paolo Past ɉɪɟɡɢɞɟɧɬ, Italian Society of Physical and Rehabilitation Medicine (SIMFER)
Former Director, Dept.of Rehabilitation Medicine,
ULSS2 Marca Trevigiana and Rehabilitation Hospital Motta di Livenza, Treviso, ȱɬɚɥɿɹ
Boyer François Constant Sébastopol Hospital, PMR department, Reims Champagne University, Ɏɪɚɧɰɿɹ
Burn John PS Poole Hospital, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Cantista Pedro Centro Hospitalar Universitário do Porto
ICBAS – Universidade do Porto, ɉɨɪɬɭɝɚɥɿɹ
Ceravolo Maria Gabriella ɉɪɟɡɢɞɟɧɬ Ɋɚɞɢ ɎɊɆ ȯɋɆɋ
Department of Experimental and Clinical Medicine
Politecnica University of Marche, ȱɬɚɥɿɹ
Christodoulou Nicolas ɉɪɟɡɢɞɟɧɬ ɋɟɤɰɿʀ ɎɊɆ ȯɋɆɋ
European University Cyprus – Medical School
Limassol Centre of PRM, Ʉɿɩɪ
Delarque Alain ɉɪɟɡɢɞɟɧɬ ȯɜɪɨɩɟɣɫɶɤɨɝɨ Ɍɨɜɚɪɢɫɬɜɚ Ɏɿɡɢɱɧɨʀ ɬɚ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɨʀ Ɇɟɞɢɰɢɧɢ
(ȯɌɎɊɆ)
Pôle Médical Intersites de Médecine Physique et de Réadaptation-Médecine du Sport
Institut Universitaire de Réadaptation (IUR)
Institut des Neurosciences de La Timone (INT)
Marseille, Ɏɪɚɧɰɿɹ
Deveþerski Gordana Clinic for medical rehabilitation, Clinic center of Vojvodina
Medical faculty, University of Novi Sad, Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ
Didier Jean-Pierre Secrétaire général adjoint de l’Académie Européenne de Médecine Physique
Médecine Physique et Réadaptation
Université de Bourgogne-Franche Comté, Ɏɪɚɧɰɿɹ
Foti Calogero Tor Vergata University, Rome, ȱɬɚɥɿɹ
Franchignoni Franco ɉɚɫɬ-ɉɪɟɡɢɞɟɧɬ ɬɚ ɉɨɠɢɬɬɽɜɢɣ ɑɥɟɧ Ɋɚɞɢ ɎɊɆ ȯɋɆɋ
ɉɨɱɟɫɧɢɣ ɱɥɟɧ ȯɜɪɨɩɟɣɫɶɤɨʀ Ⱥɤɚɞɟɦɿʀ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɨʀ Ɇɟɞɢɰɢɧɢ,
Novara, ȱɬɚɥɿɹ
Grimby Gunnar Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Physiology and
Neuroscience, Sahlgrenska Academy at University of Gothenburg, Gothenburg, ɒɜɟɰɿɹ
Gutenbrunner Christoph Department of Rehabilitation Medicine
Hannover Medical School, ɇɿɦɟɱɱɢɧɚ
Ilieva Elena M. Medical University of Plovdiv
Department of Physical and Rehabilitation Medicine, Ȼɨɥɝɚɪɿɹ
Janssen Wim G.M. Consultant Rehabilitation Medicine
Dept Rehabilitation Medicine, rve Erasmus MC Rijndam, Rotterdam, ɇɿɞɟɪɥɚɧɞɢ
Juocevicius Alvydas The Rehabilitation, Physical and Sports Medicine Center
Vilnius University Hospital Santaros Klinikos, Ʌɢɬɜɚ
Kiekens Carlotte Physical and Rehabilitation Medicine
University Hospitals Leuven
Leuven, Ȼɟɥɶɝɿɹ

26 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Ïåðø³ àâòîðè (ïðîäîâæåííÿ)

Küçükdeveci Ayúe A. Ankara University, Faculty of Medicine

Department of Physical Medicine and Rehabilitation, Ɍɭɪɟɱɱɢɧɚ
Lains Jorge Centro de Medicina de Reabilitação – Rovisco Pais, Universidade Católica – Medical
Dentistry School,
ABPG – PRM Department
Coimbra, ɉɨɪɬɭɝɚɥɿɹ
Laxe Sara Brain injury and Neurorehabilitation
Institut Guttmann, Hospital for Neurorehabilitation linked to UAB, Badalona, Barcelona,
ȱɫɩɚɧɿɹ
Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), ȱɫɩɚɧɿɹ
Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona,
Barcelona, ȱɫɩɚɧɿɹ
McElligott Jacinta National Rehabilitation Hospital, Dun Laoghaire Co
Dublin, ȱɪɥɚɧɞɿɹ
McNamara Angela National Rehabilitation Hospital
Dublin, ȱɪɥɚɧɞɿɹ
Michail Xanthi ɉɪɟɡɢɞɟɧɬ ȯȺɊɆ
Faculty of Health and Caring Professions
Athens University of Applied Sciences, Ƚɪɟɰɿɹ
Negrini Stefano Clinical and Experimental Sciences Department, University of Brescia, Brescia, ȱɬɚɥɿɹ
IRCCS Fondazione Don Gnocchi, Milan, ȱɬɚɥɿɹ
Oral Aydan Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul
University, Istanbul, Ɍɭɪɟɱɱɢɧɚ
Özçakar Levent Hacettepe University Medical School
Department of Physical and Rehabilitation Medicine
Ankara, Ɍɭɪɟɱɱɢɧɚ
Quittan Michael Institute of Physical Medicine & Rehabilitation
Kaiser-Franz-Josef Hospital, Vienna, Ⱥɜɫɬɪɿɹ
Rapidi Christina-Anastasia Vice ɉɪɟɡɢɞɟɧɬ of the Hellenic Society of PRM
ɉɪɟɡɢɞɟɧɬ of the SCI Section of the Hellenic Society of PRM
Chair of Special Interest Scientific Committee for SCI of the European Society of PRM
PRM Department, General Hospital “G.Gennimatas”, Athens, Ƚɪɟɰɿɹ
Rode Gilles Université de Lyon
Neuroscience Research Center, ImpAct Team
Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap,
Lyon, Ɏɪɚɧɰɿɹ
Singh Rajiv K Sheffield Teaching Hospitals/University of Sheffield, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Sjölund Bengt H. Dept. of. Public Health
University of Southern Denmark, Ⱦɚɧɿɹ
Stam Henk J. Erasmus Medical Center, Rehabilitation Medicine
St. Jansteen, ɇɿɞɟɪɥɚɧɞɢ
Stucki Gerold Department of Health Sciences and Health Policy, Faculty of Humanities and Social
Sciences, University of Lucerne, Lucerne, Switzerland
Swiss Paraplegic Research (SPF), Nottwil, ɒɜɟɣɰɚɪɿɹ
ICF Research Branch, a cooperation partner within the WHO Collaborating Centre for the
Family of International Classifications in ɇɿɦɟɱɱɢɧɚ (at DIMDI), Nottwil, ɒɜɟɣɰɚɪɿɹ
Takáþ Peter Pavol Jozef Safarik University Faculty of Medicine Kosice and L. Pasteur University
Hospital, Department of Physical and Rehabilitation Medicine, Kosice, ɋɥɨɜɚɱɱɢɧɚ
Tederko Piotr Department of Rehabilitation of the 1st Medical Faculty, Medical University of Warsaw,
ɉɨɥɶɳɚ
Ward Anthony B North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke on Trent, ȼɟɥɢɤɚ
Ȼɪɢɬɚɧɿɹ
Staffordshire University, Stoke on Trent, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Zampolini Mauro Ƚɟɧɟɪɚɥɶɧɢɣ ɋɟɤɪɟɬɚɪ ɋɟɤɰɿʀ ɎɊɆ ȯɋɆɋ
Rehabilitation Network of Umbria Region
Foligno Hospital, Foligno (Perugia), ȱɬɚɥɿɹ

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 27
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

ɋɩɿɜɚɜɬɨɪɢ
Aguiar-Branco Catarina PRM Department, CHEDV – Hospital Feira
MD Faculty, University of Oporto, ɉɨɪɬɭɝɚɥɿɹ
Aivars Vetra Riga Stradins University, Riga, Ʌɚɬɜɿɹ
Antunes Filipe Portuguese delegate and national manager of Ordem dos Médicos to UEMS Board and
Section, ɉɨɪɬɭɝɚɥɿɹ
Bardot Philippe DES de médecine physique et réadaptation
Médecin chef de pôle enfants /adolescents
IRF Pomponiana Olbia
Hyeres, Ɏɪɚɧɰɿɹ
Barotsis Nikolaos ɇɚɫɬɭɩɧɢɣ ɉɪɟɡɢɞɟɧɬ Ɋɚɞɢ ɎɊɆ ȯɋɆɋ
Academic & Research Fellow, Rehabilitation Centre, Patras University, Rio – Ƚɪɟɰɿɹ
PRM Outpatient Clinic, Naxos, Ƚɪɟɰɿɹ
Bertolini Carlo (+) ɉɨɱɟɫɧɢɣ ɱɥɟɧ ȯȺɊɆ
ɉɚɫɬ-ɉɪɟɡɢɞɟɧɬ Ɋɚɞɢ ɎɊɆ ȯɋɆɋ
Professor in PRM, Rome, ȱɬɚɥɿɹ
Bickenbach Jerome Department of Health Sciences and Health Policy, University of Lucerne and Swiss
Paraplegic Research (SPF), Nottwil, ɒɜɟɣɰɚɪɿɹ
Borg Kristian Division of Rehabilitation Medicine, department of Clinical Sciences, Karolinska Institutet,
Dandeyd University Hospital, Stockholm, ɒɜɟɰɿɹ
Cantista Pedro Centro Hospitalar Universitário do Porto
ICBAS – Universidade do Porto, ɉɨɪɬɭɝɚɥɿɹ
Ceravolo Maria Gabriella ɉɪɟɡɢɞɟɧɬ Ɋɚɞɢ ɎɊɆ ȯɋɆɋ
Department of Experimental and Clinical Medicine
Politecnica University of Marche, ȱɬɚɥɿɹ
Chaler Joaquim PM&R department. Egarsat. Terrassa. Catalonia. ȱɫɩɚɧɿɹ
Editor-in-chief. Rehabilitación(Madr). Spanish Society of PM&R (SERMEF), Madrid,
ȱɫɩɚɧɿɹ
EUSES Physiotherapy Interuniversity Degree. Universitat de Girona-Universitat de
Barcelona. Campus Bellvitge. L'Hospitalet, Catalonia, ȱɫɩɚɧɿɹ
Chamberlain Anne Emeritus Prof Of Rehabilitation Medicine, University of Leeds, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Christodoulou Nicolas ɉɪɟɡɢɞɟɧɬ ɋɟɤɰɿʀ ɎɊɆ ȯɋɆɋ
European University Cyprus – Medical School
Limassol Centre of PRM, Ʉɿɩɪ
Delargy Mark National Rehabilitation Hospital, Dublin, ȱɪɥɚɧɞɿɹ
Delarque Alain ɉɪɟɡɢɞɟɧɬ ȯɜɪɨɩɟɣɫɶɤɨɝɨ Ɍɨɜɚɪɢɫɬɜɚ Ɏɿɡɢɱɧɨʀ ɬɚ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɨʀ Ɇɟɞɢɰɢɧɢ (ȯɌɎɊɆ)
Pôle Médical Intersites de Médecine Physique et de Réadaptation -Médecine du Sport
Institut Universitaire de Réadaptation (IUR)
Institut des Neurosciences de La Timone (INT)
Marseille, Ɏɪɚɧɰɿɹ
Deveþerski Gordana Clinic for medical rehabilitation, Clinic center of Vojvodina
Medical faculty, University of Novi Sad, Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ
Didier Jean-Pierre Secrétaire général adjoint de l’Académie Européenne de Médecine Physique
Médecine Physique et Réadaptation
Université de Bourgogne-Franche Comté, Ɏɪɚɧɰɿɹ
Foti Calogero Tor Vergata University, Rome, ȱɬɚɥɿɹ
Franchignoni Franco ɉɚɫɬ-ɉɪɟɡɢɞɟɧɬ ɬɚ ɉɨɠɢɬɬɽɜɢɣ ɑɥɟɧ Ɋɚɞɢ ɎɊɆ ȯɋɆɋ
ɉɨɱɟɫɧɢɣ ɱɥɟɧ ȯɜɪɨɩɟɣɫɶɤɨʀ Ⱥɤɚɞɟɦɿʀ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɨʀ Ɇɟɞɢɰɢɧɢ,
Novara, ȱɬɚɥɿɹ
Giustini Alessandro Rehabilitation Hospital San Pancrazio (Trento-Arco)
Scientific Committee Rehabilitation Santo Stefano Group, ȱɬɚɥɿɹ
Glaesener Jean-Jacques Berufsgenossenschaftliches Unfallkrankenhaus
Zentrum für Rehabilitationsmedizin
Hamburg, ɇɿɦɟɱɱɢɧɚ
Grabljevec Klemen University Rehabilitation Institute, Ljubljana, ɋɥɨɜɟɧɿɹ
Grimby Gunnar Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Physiology and
Neuroscience, Sahlgrenska Academy at University of Gothenburg, Gothenburg, ɒɜɟɰɿɹ
Gutenbrunner Christoph Department of Rehabilitation Medicine
Hannover Medical School, ɇɿɦɟɱɱɢɧɚ

28 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Ñï³âàâòîðè (ïðîäîâæåííÿ)

Hornáþek Karol Slovenská zdravotnícka univerzita

(Slovak Healthcare University) Bratislava, ɋɥɨɜɚɱɱɢɧɚ
Jandric Slavica Dj. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of
Banja Luka, Banja Luka, Republic of Srpska, Ȼɨɫɧɿɹ ɬɚ Ƚɟɪɰɟɝɨɜɢɧɚ
Janssen Wim G.M. Consultant Rehabilitation Medicine
Dept Rehabilitation Medicine, rve Erasmus MC Rijndam, Rotterdam, Ƚɨɥɚɧɞɿɹ
Juocevicius Alvydas The Rehabilitation, Physical and Sports Medicine Center, Vilnius University Hospital
Santaros Klinikos, Vilnius, Ʌɢɬɜɚ
Kiekens Carlotte Physical and Rehabilitation Medicine
University Hospitals Leuven
Leuven, Ȼɟɥɶɝɿɹ
Küçükdeveci Ayúe A. Ankara University, Faculty of Medicine
Department of Physical Medicine and Rehabilitation, Ɍɭɪɟɱɱɢɧɚ
Kujawa Jolanta Department of PRM, Medical University of Lodz, ɉɨɥɶɳɚ
Laxe Sara Brain injury and Neurorehabilitation
Institut Guttmann, Hospital for Neurorehabilitation linked to UAB, Badalona, Barcelona,
ȱɫɩɚɧɿɹ
Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), ȱɫɩɚɧɿɹ
Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona,
Barcelona, ȱɫɩɚɧɿɹ
Marinþek ýrt University of Ljubljana, SFEBPRM, EAPRM (Hon.Mem.), Editor-in-Chief of the Int. J.
Rehab. Res., ɋɥɨɜɟɧɿɹ
McElligott Jacinta National Rehabilitation Hospital, Dun Laoghaire Co Dublin, ȱɪɥɚɧɞɿɹ
McNamara Angela National Rehabilitation Hospital
Dublin, ȱɪɥɚɧɞɿɹ
Michail Xanthi ɉɪɟɡɢɞɟɧɬ ȯȺɊɆ
Faculty of Health and Caring Professions
Athens University of Applied Sciences, Ƚɪɟɰɿɹ
Michel Carine Unité de Formation et de Recherche en Sciences et Techniques des Activités Physiques et
Sportives, Campus Universitaire, Université de Bourgogne, Dijon, Ɏɪɚɧɰɿɹ
INSERM, U 1093, Cognition, Action et Plasticité Sensorimotrice, Dijon, Ɏɪɚɧɰɿɹ
Moslavac Saša Spinal Unit, Special Hospital for Medical Rehabilitation Varaždinske Toplice
Referral Centre for Rehabilitation of Spinal Cord Injuries, Ministry of Health, ɏɨɪɜɚɬɿɹ
Negrini Stefano Clinical and Experimental Sciences Department, University of Brescia, Brescia, ȱɬɚɥɿɹ
IRCCS Fondazione Don Gnocchi, Milan, ȱɬɚɥɿɹ
Nulle Anda National Rehabilitation centre “Vaivari”, Jurmala, Ʌɚɬɜɿɹ
Nunes Renato Department of Pediatric Rehabilitation Unit
Department of Traumatic Brain Injury Rehabilitation Unit
Neuropsychological Rehabilitation
Centro de Reabilitação do Norte, Porto, ɉɨɪɬɭɝɚɥɿɹ
Portuguese Society of Physical and Rehabilitation Medicine (Vice-ɉɪɟɡɢɞɟɧɬ)
Portuguese Journal of Physical and Rehabilitation Medicine (Editor-in-Chief)
Oral Aydan Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul
University, Istanbul, Ɍɭɪɟɱɱɢɧɚ
Páscoa Pinheiro João PRM Department, Faculty of Medicine, Coimbra University, ɉɨɪɬɭɝɚɥɿɹ
Paysant Jean Institut Régional de médecine physique et de réadaptation, Nancy, Ɏɪɚɧɰɿɹ
Pérennou Dominic Dept de MPR, Institut de Rééducation, Hôpital sud CHU-Grenoble-Alpes, Echirolles,
Ɏɪɚɧɰɿɹ
Popa Daiana Rehabilitation Hospital Felix Spa
General Secretary of Romanian Society of Rehabilitation Medicine, Ɋɭɦɭɧɿɹ
Rapin Amandine Sébastopol Hospital, PMR Department, Reims Champagne Ardenne University, Reims,
Ɏɪɚɧɰɿɹ
Rossetti Yves Université de Lyon, Université Lyon 1, INSERM U1028; CNRS UMR5292; Lyon
Neuroscience Research Center, ImpAct Team, Lyon, Ɏɪɚɧɰɿɹ
Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap,
Lyon, Ɏɪɚɧɰɿɹ
Rosulescu Eugenia Department of Physiotherapy and Sports Medicine
University of Craiova, Ɋɭɦɭɧɿɹ
Singh Rajiv K Sheffield Teaching Hospitals/University of Sheffield, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Smolenski Ulrich Christian Institute of Physiotherapy – University Hospital / Friedrich Schiller University of Jena,
ɇɿɦɟɱɱɢɧɚ

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 29
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Ñï³âàâòîðè (ïðîäîâæåííÿ)

Stam Henk J. Erasmus Medical Center, Rehabilitation Medicine

St. Jansteen, ɇɿɞɟɪɥɚɧɞɢ
Stibrant Sunnerhagen Katharina Institute of neuroscience and physiology, Sahlgrenska Academy, Univ of Gothenburg,
ɒɜɟɰɿɹ
Takáþ Peter Pavol Jozef Safarik University Faculty of Medicine Kosice and L. Pasteur University
Hospital, Department of Physical and Rehabilitation Medicine, Kosice, ɋɥɨɜɚɱɱɢɧɚ
Tesio Luigi Physical and Rehabilitation Medicine, Università degli Studi
Director, Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano-IRCCS,
Milano, ȱɬɚɥɿɹ
Valero-Alcaide Raquel Department Physical Medicine and Rehabilitation
Universidad Complutense de Madrid, ȱɫɩɚɧɿɹ
Varela-Donoso Enrique Physical and Rehabilitation Medicine Department, Complutense University, Madrid, ȱɫɩɚɧɿɹ
Votava Jiri Faculty of Health Studies, University of J.E. Purkyne, Usti nad Labem, ɑɟɯɿɹ
Wade Derick T Movement Science Group
Oxford Brookes University, Oxford, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Ward Anthony B Professor of Rehabilitation Medicine, North Staffordshire Rehabilitation Centre, Haywood
Hospital, Stoke on Trent, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Staffordshire University, Stoke on Trent, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Wever Daniel Rehabilitation centre Roessingh, Enschede, ɇɿɞɟɪɥɚɧɞɢ
Winkelmann Andreas Department for Orhopaedic surgery, Physical medicine and rehabilitation
Medical faculty of the University of Munich, ɇɿɦɟɱɱɢɧɚ
Zampolini Mauro Ƚɟɧɟɪɚɥɶɧɢɣ ɋɟɤɪɟɬɚɪ ɋɟɤɰɿʀ ɎɊɆ ȯɋɆɋ
Rehabilitation Network of Umbria Region
Foligno Hospital, Foligno (Perugia), ȱɬɚɥɿɹ

ȼɧɭɬɪɿɲɧɿ ɪɟɰɟɧɡɟɧɬɢ
Aguiar-Branco Catarina PRM Department, CHEDV – Hospital Feira
MD Faculty, University of Oporto, ɉɨɪɬɭɝɚɥɿɹ
Borg Kristian Division of Rehabilitation Medicine, department of Clinical Sciences, Karolinska Institutet,
Dandeyd University Hospital, Stockholm, ɒɜɟɰɿɹ
Ceravolo Maria Gabriella ɉɪɟɡɢɞɟɧɬ Ɋɚɞɢ ɎɊɆ ȯɋɆɋ
Department of Experimental and Clinical Medicine
Politecnica University of Marche, ȱɬɚɥɿɹ
Christodoulou Nicolas ɉɪɟɡɢɞɟɧɬ ɋɟɤɰɿʀ ɎɊɆ ȯɋɆɋ
European University Cyprus – Medical School
Limassol Centre of PRM, Ʉɿɩɪ
Damjan Hermina ɋɥɨɜɟɧɿɹ
Delarque Alain ɉɪɟɡɢɞɟɧɬ ȯɜɪɨɩɟɣɫɶɤɨɝɨ Ɍɨɜɚɪɢɫɬɜɚ Ɏɿɡɢɱɧɨʀ ɬɚ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɨʀ Ɇɟɞɢɰɢɧɢ
(ȯɌɎɊɆ)
Pôle Médical Intersites de Médecine Physique et de Réadaptation -Médecine du Sport
Institut Universitaire de Réadaptation (IUR)
Institut des Neurosciences de La Timone (INT)
Marseille, Ɏɪɚɧɰɿɹ
Deveþerski Gordana Clinic for medical rehabilitation, Clinic center of Vojvodina
Medical faculty, University of Novi Sad, Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ
Didier Jean-Pierre Secrétaire général adjoint de l’Académie Européenne de Médecine Physique
Professeur émérite
Médecine Physique et Réadaptation
Université de Bourgogne-Franche Comté, Ɏɪɚɧɰɿɹ
Fazekas Gabor National Institute for Medical Rehabilitation, Budapest, ɍɝɨɪɳɢɧɚ
Foti Calogero Tor Vergata University, Rome, ȱɬɚɥɿɹ
Frischknecht Rolf ȼɢɤɨɧɚɜɱɢɣ Ʉɨɦɿɬɟɬ ɋɟɤɰɿʀ Ɏɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ ȯɋɆɋ
Unit for Neurorehabilitation and Physical Medicine, Department of Clinical
Neurosciences, Lausanne University Hospital, 1011 Lausanne, ɒɜɟɣɰɚɪɿɹ
Giustini Alessandro Scientific Director Rehabilitation Hospital San Pancrazio (Trento-Arco)
Scientific Committee Rehabilitation Santo Stefano Group, ȱɬɚɥɿɹ
Glaesener Jean-Jacques Berufsgenossenschaftliches Unfallkrankenhaus
Zentrum für Rehabilitationsmedizin
Hamburg, ɇɿɦɟɱɱɢɧɚ

30 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Âíóòð³øí³ ðåöåíçåíòè (ïðîäîâæåííÿ)

Gutenbrunner Christoph Department of Rehabilitation Medicine

Hannover Medical School, ɇɿɦɟɱɱɢɧɚ
Juocevicius Alvydas The Rehabilitation, Physical and Sports Medicine Center, Vilnius University Hospital Santaros
Klinikos, Vilnius, Ʌɢɬɜɚ
Kiekens Carlotte Physical and Rehabilitation Medicine
University Hospitals Leuven
Leuven, Ȼɟɥɶɝɿɹ
Küçükdeveci Ayúe A. Ankara University, Faculty of Medicine
Department of Physical Medicine and Rehabilitation, Ɍɭɪɟɱɱɢɧɚ
Kujawa Jolanta Department of PRM, Medical University of Lodz, ɉɨɥɶɳɚ
Laxe Sara Brain injury and Neurorehabilitation
Institut Guttmann, Hospital for Neurorehabilitation linked to UAB, Badalona, Barcelona, ȱɫɩɚɧɿɹ
Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), ȱɫɩɚɧɿɹ
Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona,
Barcelona, ȱɫɩɚɧɿɹ
Lejeune Thierry Physical Medicine and Rehabilitation
Cliniques universitaires Saint-Luc
Université catholique de Louvain, Bruxelles, Ȼɟɥɶɝɿɹ
Moslavac Saša Spinal Unit, Special Hospital for Medical Rehabilitation Varaždinske Toplice
Referral Centre for Rehabilitation of Spinal Cord Injuries, Ministry of Health, ɏɨɪɜɚɬɿɹ
Negrini Stefano Clinical and Experimental Sciences Department, University of Brescia, Brescia, ȱɬɚɥɿɹ
IRCCS Fondazione Don Gnocchi, Milan, ȱɬɚɥɿɹ
Nunes Renato Department of Pediatric Rehabilitation Unit
Department of Traumatic Brain Injury Rehabilitation Unit
Neuropsychological Rehabilitation
Centro de Reabilitação do Norte, Porto, ɉɨɪɬɭɝɚɥɿɹ
Portuguese Society of Physical and Rehabilitation Medicine (Vice-ɉɪɟɡɢɞɟɧɬ)
Portuguese Journal of Physical and Rehabilitation Medicine (Editor-in-Chief), ɉɨɪɬɭɝɚɥɿɹ
Páscoa Pinheiro João PRM Department, Faculty of Medicine. Coimbra University, ɉɨɪɬɭɝɚɥɿɹ
Paternostro-Sluga Tatjana Department of Physical Medicine and Rehabilitation
Vienna Danube Hospital, Social Medical Center East, Vienna, Ⱥɜɫɬɪɿɹ
Playford Diane Warwick Medical School, University of Warwick, Central England Rehabilitation Unit, South
Warwickshire Foundation Trust, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Popa Daiana Rehabilitation Hospital Felix Spa
General Secretary of Romanian Society of Rehabilitation Medicine, Ɋɭɦɭɧɿɹ
Rapidi Christina-Anastasia Vice ɉɪɟɡɢɞɟɧɬ of the Hellenic Society of PRM
ɉɪɟɡɢɞɟɧɬ of the SCI Section of the Hellenic Society of PRM
Chair of Special Interest Scientific Committee for SCI of the European Society of PRM
PRM Department, General Hospital “G.Gennimatas”, Athens, Ƚɪɟɰɿɹ
Rode Gilles Université de Lyon
Neuroscience Research Center, ImpAct Team
Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, Lyon,
Ɏɪɚɧɰɿɹ
Sjölund Bengt H. Dept. of. Public Health
University of Southern Denmark, Ⱦɚɧɿɹ
Stibrant Sunnerhagen Institute of neuroscience and physiology, Sahlgrenska Academy, Univ of Gothenburg, ɒɜɟɰɿɹ
Katharina
Stucki Gerold Department of Health Sciences and Health Policy, Faculty of Humanities and Social Sciences,
University of Lucerne, Lucerne, Switzerland
Swiss Paraplegic Research (SPF), Nottwil, ɒɜɟɣɰɚɪɿɹ
ICF Research Branch, a cooperation partner within the WHO Collaborating Centre for the Family
of International Classifications in ɇɿɦɟɱɱɢɧɚ (at DIMDI), Nottwil, ɒɜɟɣɰɚɪɿɹ
Takáþ Peter Pavol Jozef Safarik University Faculty of Medicine Kosice and L. Pasteur University Hospital,
Department of Physical and Rehabilitation Medicine, Kosice, ɋɥɨɜɚɱɱɢɧɚ
Valero-Alcaide Raquel Department Physical Medicine and Rehabilitation
Universidad Complutense de Madrid, ȱɫɩɚɧɿɹ
Vetra Aivars Riga Stradins University, Riga, Ʌɚɬɜɿɹ
Ward Anthony B North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke on Trent, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ.
Professor of Rehabilitation Medicine, Staffordshire University, Stoke on Trent, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Wever Daniel Rehabilitation centre Roessingh, Enschede, ɇɿɞɟɪɥɚɧɞɢ
Zampolini Mauro Ƚɟɧɟɪɚɥɶɧɢɣ ɋɟɤɪɟɬɚɪ ɋɟɤɰɿʀ ɎɊɆ ȯɋɆɋ
Rehabilitation Network of Umbria Region
Foligno Hospital, Foligno (Perugia), ȱɬɚɥɿɹ

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 31
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Ɂɨɜɧɿɲɧɿ ɪɟɰɟɧɡɟɧɬɢ
Avellanet Mercè Rehabilitation Department, Hospital N Sra de Meritxell, Ⱥɧɞɨɪɪɚ
Basaglia Nino Department of Neuroscience and Rehabilitation
University Hospital of Ferrara, ȱɬɚɥɿɹ
Bickenbach Jerome Department of Health Sciences and Health Policy, University of Lucerne and Swiss
Paraplegic Research (SPF), Nottwil, ɒɜɟɣɰɚɪɿɹ
Bradley Lloyd Western Sussex Hospitals NHS Trust, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Brocard Frédéric Team P3M, Institut de Neurosciences de la Timone (UMR7289), Aix-Marseille Université
and CNRS, Marseille, Ɏɪɚɧɰɿɹ
Castellote Juan M. National School of Occupational Medicine, Carlos III Institute ofHealth, Madrid, ȱɫɩɚɧɿɹ
Department of Physical Medicine and Rehabilitation, School ofMedicine, Complutense
University of Madrid, Madrid, ȱɫɩɚɧɿɹ
Dy Rochelle T. Baylor College of Medicine
Pediatric Rehabilitation Medicine Fellowship Program Director, Houston, Texas, ɋɒȺ
Frontera Walter University of Puerto Rico School of Medicine, ɋɒȺ
Garreta Figuera Roser Universitari Mútua de Terrassa. ȱɫɩɚɧɿɹ
Egarsat, Barcelona, ȱɫɩɚɧɿɹ
Geertzen Jan HB Department of Rehabilitation Medicine
Department of Sports Medicine
University Medical Center Groningen
UMCG, member of the board of Center of Excellence for Rehabilitation, ɇɿɞɟɪɥɚɧɞɢ
Gimigliano Francesca Department of Mental and Physical Health and Preventive Medicine
University of Campania "Luigi Vanvitelli", Naples, ȱɬɚɥɿɹ
Haig Andrew J. Physical Medicine and Rehabilitation, The University of Michigan Ann Arbor, Michigan,
ɋɒȺ
Hoppe Kurt Mayo Clinic
Rochester, MN, ɋɒȺ
Imamura Marta Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade
de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Ȼɪɚɡɿɥɿɹ
Jacquemin Géraldine Université de Montréal, Montreal Gingras-Lindsay Rehabilitation Institute, Canada
Centre Hospitalier Valida, Brussels, Ȼɟɥɶɝɿɹ
Li Jianan First Affiliated Hospital of Nanjing Medical University, Ʉɢɬɚɣ
Immediate Past ɉɪɟɡɢɞɟɧɬ of International Society of Physical and Rehabilitation Medicine,
Geneva, ɒɜɟɣɰɚɪɿɹ
Medical Rehabilitation Center, First Affiliated Hospital of Nanjing Medical University,
Ʉɢɬɚɣ
Zhongshan Rehabilitation Hospital affiliated to Nanjing Medical University, Ʉɢɬɚɣ
Chinese Society of Physical Medicine and Rehabilitation
International associate of National Academy of Medicine, ɋɒȺ
Li Leonard Division of Rehabilitation, Department of Medicine
Tung Wah Hospital and University of Hong Kong, Ƚɨɧɤɨɧɝ
Martínez Assucena María Amparo Rehabilitation Department of Hospital Requena, Valencia, ȱɫɩɚɧɿɹ
Miangolarra-Page JC “Rey Juan Carlos” University, Laboratory of Movement Analysis, Biomechanics,
Ergonomics and Motor Control
Fuenlabrada University Hospital, Madrid, ȱɫɩɚɧɿɹ
Neumann Vera Consultant and Honorary Senior Lecturer, Rehabilitation Medicine, Leeds Teaching
Hospitals NHS Trust and University of Leeds (retired), ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
O'Connor Rory J Charterhouse Professor of Rehabilitation Medicine, Academic Department of Rehabilitation
Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine,
Faculty of Medicine and Health, University of Leeds, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ
Padua Luca Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro
Cuore, Rome, ȱɬɚɥɿɹ
Don Carlo Gnocchi Onlus Foundation, Milan, ȱɬɚɥɿɹ
Pérennou Dominic Dept de MPR, Institut de Rééducation, Hôpital sud CHU-Grenoble-Alpes, Echirolles,
Ɏɪɚɧɰɿɹ
Pinto Camelo António Serviço de Medicina Física e de Reabilitação
Centro Hospitalar do Porto, ɉɨɪɬɭɝɚɥɿɹ
Pistarini Caterina Neurorehabilitation
Director of ICS Maugeri Institute Genova Nervi, ȱɬɚɥɿɹ
Rimbaut Steven Algemeen Stedelijk Ziekenhuis Aalst-Geraardsbergen-Wetteren, Ȼɟɥɶɝɿɹ

32 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Çîâí³øí³ ðåöåíçåíòè (ïðîäîâæåííÿ)

Sampaio Francisco Physical Medicine and Rehabilitation Unit

Serviço de Medicina Física e de Reabilitação, Centro Hospitalar Lisboa Norte, Lisboa,
ɉɨɪɬɭɝɚɥɿɹ.
Instituto de Fisiologia, Clínica Universitária de Medicina Física e de Reabilitação, Faculdade
de Medicina, Universidade de Lisboa,
Lisboa, ɉɨɪɬɭɝɚɥɿɹ
Schuhfried Othmar Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Ⱥɜɫɬɪɿɹ
Smania Nicola Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences,
Biomedicine and Movement Sciences, University of Verona, Verona, ȱɬɚɥɿɹ.
Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona,
ȱɬɚɥɿɹ
Smit Christof A.J. Revalidatiearts Expertisecentrum Dwarslaesie
Opleider (locatie Overtoom), Amsterdam, ɇɿɞɟɪɥɚɧɞɢ
Soares Branco Pedro Centro Hospitalar de Lisboa Central/NOVA Medical School, ɉɨɪɬɭɝɚɥɿɹ
Tang Simon F Department of Rehabilitation Medicine, Chang Gung Memorial Hospital and Chang Gung
University, Taoyuan City, Ɍɚɣɜɚɧɶ
Tennant Alan Schweizer Paraplegiker-Forschung, Nottwil, ɒɜɟɣɰɚɪɿɹ
Tesio Luigi Physical and Rehabilitation Medicine, Università degli Studi
Director, Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano-IRCCS,
Milano, ȱɬɚɥɿɹ
Thevenon André PRM department, Lille, Ɏɪɚɧɰɿɹ
Medicine Faculty, Université Lille2, Lille, Ɏɪɚɧɰɿɹ
van Nes Ilse J.W. Sint Maartenskliniek, Dept. Of Rehabilitation, GM Nijmegen, ɇɿɞɟɪɥɚɧɞɢ
Vlak Tonko Institute of Rehabilitation Medicine and Rheumatology, Clinical Hospital Center Split
School of Medicine University of Split, Split, ɏɨɪɜɚɬɿɹ
Weinstein Stuart M. University of Washington, Seattle, WA, ɋɒȺ
Departments of Rehabilitation Medicine, Orthopaedic Surgery and Sports Medicine, and
Neurological Surgery
Editor-in-Chief, PM&R
Yelnik Alain GH St.Louis-Lariboisière-F.Widal, AP-HP
Paris Diderot University, Paris, Ɏɪɚɧɰɿɹ

ªâðîïåéñüêà Àêàäåì³ÿ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ)

ȼɢɤɨɧɚɜɱɢɣ ɤɨɦɿɬɟɬ
Michail Xanthi (Ƚɪɟɰɿɹ) – ɉɪɟɡɢɞɟɧɬ Gutenbrunner Christoph (ɇɿɦɟɱɱɢɧɚ)
Ward Anthony B (ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ) – ȼɿɰɟ-ɩɪɟɡɢɞɟɧɬ Lankhorst Gustaaf (ɇɿɞɟɪɥɚɧɞɢ)
McNamara Angela (ȱɪɥɚɧɞɿɹ) – ɋɟɤɪɟɬɚɪ Sjölund Bengt H. (ɒɜɟɰɿɹ)
Didier Jean-Pierre (Ɏɪɚɧɰɿɹ) – Ɂɚɫɬɭɩɧɢɤ ɋɟɤɪɟɬɚɪɹ Stucki Gerold (ɒɜɟɣɰɚɪɿɹ)
Stam Henk J. (ɇɿɞɟɪɥɚɧɞɢ) – ɋɤɚɪɛɧɢɤ Vanderstraeten Guy (Ȼɟɥɶɝɿɹ)
Delarque Alain (Ɏɪɚɧɰɿɹ)

Ⱥɤɚɞɟɦɿɤɢ
Arokoski Jari (Ɏɿɧɥɹɧɞɿɹ) Malmivaara Antti (Ɏɿɧɥɹɧɞɿɹ)
Borg Kristian (ɒɜɟɰɿɹ) Marinþek ýrt (ɋɥɨɜɟɧɿɹ)
Burger Helena (ɋɥɨɜɟɧɿɹ) McNamara Angela (ȱɪɥɚɧɞɿɹ)
Ceravolo Maria Gabriella (ȱɬɚɥɿɹ) Michail Xanthi (Ƚɪɟɰɿɹ)
Chamberlain Anne (ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ) Negrini Stefano (ȱɬɚɥɿɹ)
Chantraine Alex (ɒɜɟɣɰɚɪɿɹ) Páscoa Pinheiro João (ɉɨɪɬɭɝɚɥɿɹ)
Delarque Alain (Ɏɪɚɧɰɿɹ) Paysant Jean (Ɏɪɚɧɰɿɹ)
Deltombe Thierry (Ȼɟɥɶɝɿɹ) Perrouin-Verbe Brigitte (Ɏɪɚɧɰɿɹ)
Didier Jean-Pierre (Ɏɪɚɧɰɿɹ) Playford Diane (ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ)
Ekholm Jan (ɒɜɟɰɿɹ) Rietman Johan H (ɇɿɞɟɪɥɚɧɞɢ)
Fazekas Gabor (ɍɝɨɪɳɢɧɚ) Rode Glles (Ɏɪɚɧɰɿɹ)
Franchignoni Franco (ȱɬɚɥɿɹ) Sjölund Bengt H. (ɒɜɟɰɿɹ)
Garcia-Alsina Joan (ȱɫɩɚɧɿɹ) Stam Henk J. (ɇɿɞɟɪɥɚɧɞɢ)

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 33
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Àêàäåì³êè (ïðîäîâæåííÿ)

Gobelet Charles (ɒɜɟɣɰɚɪɿɹ) Stanghelle Johan (ɇɨɪɜɟɝɿɹ)

Gutenbrunner Christoph (ɇɿɦɟɱɱɢɧɚ) Stucki Gerold (ɒɜɟɣɰɚɪɿɹ)
Juocevicius Alvydas (Ʌɢɬɜɚ) Vanderstraeten Guy (Ȼɟɥɶɝɿɹ)
Karppinen Jaro (Ɏɿɧɥɹɧɞɿɹ) Ward Anthony B (ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ)
Kiekens Carlotte (Ȼɟɥɶɝɿɹ) Zampolini Mauro (ȱɬɚɥɿɹ)
Lains Jorge (ɉɨɪɬɭɝɚɥɿɹ)
Lankhorst Gustaaf (ɇɿɞɟɪɥɚɧɞɢ)

ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ)

ȼɢɤɨɧɚɜɱɢɣ ɤɨɦɿɬɟɬ
Delarque Alain (Ɏɪɚɧɰɿɹ) – ɉɪɟɡɢɞɟɧɬ
Christodoulou Nicolas (Ʉɿɩɪ) – ɇɚɫɬɭɩɧɢɣ ɉɪɟɡɢɞɟɧɬ
Kiekens Carlotte (Ȼɟɥɶɝɿɹ) – Ƚɟɧɟɪɚɥɶɧɢɣ ɫɟɤɪɟɬɚɪ
Leches Marguerite (Ʌɸɤɫɟɦɛɭɪɝ) – Ɂɚɫɬɭɩɧɢɤ ɫɟɤɪɟɬɚɪɹ
Wever Daniel (ɇɿɞɟɪɥɚɧɞɢ) – ɋɤɚɪɛɧɢɤ
Juocevicius Alvydas (Ʌɢɬɜɚ) – Ɂɚɫɬɭɩɧɢɤ ɫɤɚɪɛɧɢɤɚ
Ilieva M. Elena (Ȼɨɥɝɚɪɿɹ) – ɋɬɚɬɭɬɢ ɬɚ ɜɧɭɬɧɿɲɧɿ ɩɪɚɜɢɥɚ
Kujawa Jolanta (ɉɨɥɶɳɚ) – ȱɧɮɨɪɦɚɰɿɹ ɬɚ ɤɨɦɭɧɿɤɚɰɿɹ
Cantista Pedro (ɉɨɪɬɭɝɚɥɿɹ) – ɑɥɟɧ
Boldrini Paolo (ȱɬɚɥɿɹ) – ɑɥɟɧ
Delargy Mark (ȱɪɥɚɧɞɿɹ) – ɑɥɟɧ
Negrini Stefano (ȱɬɚɥɿɹ) – Ɂɚɩɪɨɲɟɧɢɣ ɜɿɞ European Journal of Physical and Rehabilitation Medicine

Ⱦɟɥɟɝɚɬɢ
Aguiar-Branco Catarina (ɉɨɪɬɭɝɚɥɿɹ) Kankaanpaa Markku (Ɏɿɧɥɹɧɞɿɹ)
Aleksiev Assen (Ȼɨɥɝɚɪɿɹ) Kiekens Carlotte (Ȼɟɥɶɝɿɹ)
Bergam Grandis Renata (Ɇɨɧɬɟɧɟɝɪɨ) Kruger Liisamari (Ɏɿɧɥɹɧɞɿɹ)
Bighea Adrian (Ɋɭɦɭɧɿɹ) Kujawa Jolanta (ɉɨɥɶɳɚ)
Boldrini Paolo (ȱɬɚɥɿɹ) Laxe Sara (ȱɫɩɚɧɿɹ)
Borg Kristian (ɒɜɟɰɿɹ) Lazoviü Milica (Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ)
Boyer François Constant (Ɏɪɚɧɰɿɹ) Leches Marguerite (Ʌɸɤɫɟɦɛɭɪɝ)
Broholm Berit (Ⱦɚɧɿɹ) Lejeune Thierry (Ȼɟɥɶɝɿɹ)
Burger Helena (ɋɥɨɜɟɧɿɹ) Lukmann Aet (ȿɫɬɨɧɿɹ)
Cantista Pedro (ɉɨɪɬɭɝɚɥɿɹ) Lutsky Lena (ȱɡɪɚʀɥɶ)
Christodoulou Nicolas (Ʉɿɩɪ) Macfarlane John (ȱɪɥɚɧɞɿɹ)
Chronis Savvas Apollon (Ʉɿɩɪ) Michail Xanthi (Ƚɪɟɰɿɹ)
Damjan Hermina (ɋɥɨɜɟɧɿɹ) Nikolikj-Dimitrova Erieta (Ʉɨɥɢɲɧɹ ɘɝɨɫɥɚɜɫɶɤɚ Ɋɟɫɩɭɛɥɿɤɚ
Ɇɚɤɟɞɨɧɿɹ)
Delargy Mark (ȱɪɥɚɧɞɿɹ) Nulle Anda (Ʌɚɬɜɿɹ)
Delarque Alain (Ɏɪɚɧɰɿɹ) Özyemiúçi TaúkÕran Özden (Ɍɭɪɟɱɱɢɧɚ)
Delic Marina (Ɇɨɧɬɟɧɟɝɪɨ) Popa Daiana Mihaela (Ɋɭɦɭɧɿɹ)
Denes Zoltan (ɍɝɨɪɳɢɧɚ) Quittan Michael (Ⱥɜɫɬɪɿɹ)
Deveþerski Gordana (Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ) Rapidi Christina-Anastasia (Ƚɪɟɰɿɹ)
Dincer Fitnat (Ɍɭɪɟɱɱɢɧɚ) Renato Nunes (ɉɨɪɬɭɝɚɥɿɹ)
Dragievic Cvjetkovic Dragana (Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ) Roussos Nikos (Ƚɪɟɰɿɹ)
Fazekas Gabor (ɍɝɨɪɳɢɧɚ) Schwarzkopf Susanne (ɇɿɦɟɱɱɢɧɚ)
Foti Calogero (ȱɬɚɥɿɹ) Shamalov Nikolay (Ɋɨɫɿɹ)
Frischknecht Rolf (ɒɜɟɣɰɚɪɿɹ) Shostakiene Nijole (Ʌɢɬɜɚ)
Grabljevec Klemen (ɋɥɨɜɟɧɿɹ) Stahl Minna (Ɏɿɧɥɹɧɞɿɹ)
Grubišiü Frane (ɏɨɪɜɚɬɿɹ) Stefanovski Gordana (Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ)
Gubenko Vitaliy (ɍɤɪɚʀɧɚ) Stibrant Sunnerhagen Katharina (ɒɜɟɰɿɹ)
Gutenbrunner Christoph (ɇɿɦɟɱɱɢɧɚ) Tederko Piotr (ɉɨɥɶɳɚ)
Hansen Birgitte (Ⱦɚɧɿɹ) Treger Iuly (ȱɡɪɚʀɥɶ)
Haznere Ilze (Ʌɚɬɜɿɹ) Varela-Donoso Enrique (ȱɫɩɚɧɿɹ)
Ilieva Elena M. (Ȼɨɥɝɚɪɿɹ) Vekerdy-Nady Zsuzsanna (ɍɝɨɪɳɢɧɚ)

34 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Äåëåãàòè (ïðîäîâæåííÿ)

Ivanova Galina (Ɋɨɫɿɹ) Vladymyrov Oleksandr (ɍɤɪɚʀɧɚ)

Janssen Wim G.M. (ɇɿɞɟɪɥɚɧɞɢ) Wever Daniel (ɇɿɞɟɪɥɚɧɞɢ)
Juocevicius Alvydas (Ʌɢɬɜɚ) Wicker Anton (Ⱥɜɫɬɪɿɹ)
Jürgenson Annelii (ȯɫɬɨɧɿɹ) Zammit Stephen (Ɇɚɥɶɬɚ)
Kakulia Nelly (Ƚɪɭɡɿɹ) Ziad Hawamdeh (Ƀɨɪɞɚɧɿɹ)

Ñåêö³ÿ Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè ªâðîïåéñüêîãî Ñîþçó

Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ÔÐÌ ªÑÌÑ)

ȼɢɤɨɧɚɜɱɢɣ ɤɨɦɿɬɟɬ
ɉɪɟɡɢɞɟɧɬ ɋɟɤɰɿʀ: Christodoulou Nicolas (Ʉɿɩɪ)
Ƚɟɧɟɪɚɥɶɧɢɣ ɫɟɤɪɟɬɚɪ ɋɟɤɰɿʀ: Zampolini Mauro (ȱɬɚɥɿɹ)
ɋɤɚɪɛɧɢɤ ɋɟɤɰɿʀ: Janssen Wim G.M. (ɇɿɞɟɪɥɚɧɞɢ)
Ɂɚɫɬɭɩɧɢɤ ɫɤɚɪɛɧɢɤɚ ɋɟɤɰɿʀ: Frischknecht Rolf (ɒɜɟɣɰɚɪɿɹ)
ɉɚɫɬ-ɉɪɟɡɢɞɟɧɬ ɋɟɤɰɿʀ: Delarque Alain (Ɏɪɚɧɰɿɹ)
ɉɪɟɡɢɞɟɧɬ Ɋɚɞɢ: Ceravolo Maria Gabriella (ȱɬɚɥɿɹ)
ȼɿɰɟ-ɩɪɟɡɢɞɟɧɬ Ɋɚɞɢ ɬɚ Ɂɚɫɬɭɩɧɢɤ ɫɟɤɪɟɬɚɪɹ Ɋɚɞɢ: Barotsis Nikolaos (Ƚɪɟɰɿɹ)
Ƚɨɥɨɜɚ Ʉɨɦɿɬɟɬɭ ɤɥɿɧɿɱɧɢɯ ɫɬɨɫɭɧɤɿɜ: Delargy Mark (ȱɪɥɚɧɞɿɹ)
Ɂɚɫɬɭɩɧɢɤ ɫɟɤɪɟɬɚɪɹ ɋɟɤɰɿʀ ɜɿɞ Ʉɨɦɿɬɟɬɭ ɤɥɿɧɿɱɧɢɯ ɫɬɨɫɭɧɤɿɜ: Moses Karel (ɑɟɯɿɹ)
Ƚɨɥɨɜɚ Ʉɨɦɿɬɟɬɭ ɩɪɨɮɟɫɿɣɧɨʀ ɩɪɚɤɬɢɤɢ: Varela-Donoso Enrique (ȱɫɩɚɧɿɹ)
Ɂɚɫɬɭɩɧɢɤ ɫɟɤɪɟɬɚɪɹ ɋɟɤɰɿʀ ɜɿɞ Ʉɨɦɿɬɟɬɭ ɩɪɨɮɟɫɿɣɧɨʀ ɩɪɚɤɬɢɤɢ: Kiekens Carlotte (Ȼɟɥɶɝɿɹ)

Ⱦɟɥɟɝɚɬɢ
Angelova Tatyana (Ȼɨɥɝɚɪɿɹ) Leches Marguerite (Ʌɸɤɫɟɦɛɭɪɝ)
Antunes Filipe (ɉɨɪɬɭɝɚɥɿɹ) Lejeune Thierry (Ȼɟɥɶɝɿɹ)
Belkin Andrei (Ɋɨɫɿɹ) Lukmann Aet (ȯɫɬɨɧɿɹ)
Berteanu Mihai (Ɋɭɦɭɧɿɹ) Macfarlane John (ȱɪɥɚɧɞɿɹ)
Borg Kristian (ɒɜɟɰɿɹ) Moses Karel (ɑɟɯɿɹ)
Broholm Berit (Ⱦɚɧɿɹ) Moslavac Saša (ɏɨɪɜɚɬɿɹ)
Burger Helena (ɋɥɨɜɟɧɿɹ) Negrini Stefano (ȱɬɚɥɿɹ)
Burn John PS (ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ) Nikitina Annelii (ȿɫɬɨɧɿɹ)
Christodoulou Nicolas (Ʉɿɩɪ) Nulle Anda (Ʌɚɬɜɿɹ)
De Korvin Georges (Ɏɪɚɧɰɿɹ) Oral Aydan (Ɍɭɪɟɱɱɢɧɚ)
Delargy Mark (ȱɪɥɚɧɞɿɹ) Petronic-Markovic Ivana (Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ)
Delarque Alain (Ɏɪɚɧɰɿɹ) Popa Daiana (Ɋɭɦɭɧɿɹ)
Denes Zoltan (ɍɝɨɪɳɢɧɚ) Quittan Michael (Ⱥɜɫɬɪɿɹ)
Fazekas Gabor (ɍɝɨɪɳɢɧɚ) Rapidi Christina-Anastasia (Ƚɪɟɰɿɹ)
Frischknecht Rolf (ɒɜɟɣɰɚɪɿɹ) Roussos Nikolaos (Ƚɪɟɰɿɹ)
Glaesener Jean-Jaques (ɇɿɦɟɱɱɢɧɚ) Schwarzkopf Susanne (ɇɿɦɟɱɱɢɧɚ)
Golyk Volodymyr (ɍɤɪɚʀɧɚ) Sekelj-Kauzlariü Katarina (ɏɨɪɜɚɬɿɹ)
Grabljevec Klemen (ɋɥɨɜɟɧɿɹ) Shostakiene Nijole (Ʌɢɬɜɚ)
Gubenko Vitaliy (ɍɤɪɚʀɧɚ) Singh Rajiv K (ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ)
Hansen Birgitte (Ⱦɚɧɿɹ) Stahl Minna (Ɏɿɧɥɹɧɞɿɹ)
Haznere Ilze (Ʌɚɬɜɿɹ) Stanghelle Johan (ɇɨɪɜɟɝɿɹ)
Hornacek Karol (ɋɥɨɜɚɱɱɢɧɚ) Stefanovski Gordana (Ȼɨɫɧɿɹ ɬɚ Ƚɟɪɰɟɝɨɜɿɧɚ)
Ilieva Elena M. (Ȼɨɥɝɚɪɿɹ) Stemberger Regina (Ⱥɜɫɬɪɿɹ)
Irgens Ingeborg (ɇɨɪɜɟɝɿɹ) Stibrant Sunnerhagen Katharina (ɒɜɟɰɿɹ)
Ivanova Galina Evgenia (Ɋɨɫɿɹ) Sulaberidze Grigol (Ƚɪɭɡɿɹ)
Janssen Wim G.M. (ɇɿɞɟɪɥɚɧɞɢ) Takáþ Peter (ɋɥɨɜɚɱɱɢɧɚ)
Juocevicius Alvydas (Ʌɢɬɜɚ) Tederko Piotr (ɉɨɥɶɳɚ)
Kakulia Nelly (Ƚɪɭɡɿɹ) Valero Raquel (ȱɫɩɚɧɿɹ)
Kankaanpaa Markku (Ɏɿɧɥɹɧɞɿɹ) Varela-Donoso Enrique (ȱɫɩɚɧɿɹ)
Kiekens Carlotte (Ȼɟɥɶɝɿɹ) Votava Jiri (ɑɟɯɿɹ)
Küçükdeveci Ayúe A. (Ɍɭɪɟɱɱɢɧɚ) Wever Daniel (ɇɿɞɟɪɥɚɧɞɢ)
Kujawa Jolanta (ɉɨɥɶɳɚ) Zammit Stephen (Ɇɚɥɶɬɚ)
Lazoviü Milica (Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ) Zampolini Mauro (ȱɬɚɥɿɹ)

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 35
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

ªâðîïåéñüêèé Êîëåäæ (Ðàäà) Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèè

ȼɢɤɨɧɚɜɱɢɣ ɤɨɦɿɬɟɬ
ɉɪɟɡɢɞɟɧɬ: Ceravolo Maria Gabriella (ȱɬɚɥɿɹ)
ɉɚɫɬ-ɉɪɟɡɢɞɟɧɬ: Juocevicius Alvydas (Ʌɢɬɜɚ)
Ƚɟɧɟɪɚɥɶɧɢɣ ɋɟɤɪɟɬɚɪ: Zampolini Mauro (ȱɬɚɥɿɹ)
ȼɿɰɟ-ɩɪɟɡɢɞɟɧɬ ɬɚ Ɂɚɫɬɭɩɧɢɤ ɫɟɤɪɟɬɚɪɹ: Barotsis Nikolaos (Ƚɪɟɰɿɹ)
ɋɤɚɪɛɧɢɤ: Janssen Wim G.M. (ɇɿɞɟɪɥɚɧɞɢ)
Ɂɚɫɬɭɩɧɢɤ ɫɤɚɪɛɧɢɤɚ: Frischknecht Rolf (ɒɜɟɣɰɚɪɿɹ)
ɑɥɟɧ ex officio – ɉɪɟɡɢɞɟɧɬ ɋɟɤɰɿʀ ɎɊɆ ȯɋɆɋ: Christodoulou Nicolas (Ʉɿɩɪ)

Ⱦɟɥɟɝɚɬɢ
Aguiar-Branco Catarina (ɉɨɪɬɭɝɚɥɿɹ) Leches Marguerite (Ʌɸɤɫɟɦɛɭɪɝ)
Angelova Tatyana (Ȼɨɥɝɚɪɿɹ) Lejeune Thierry (Ȼɟɥɶɝɿɹ)
Angerova Yvona (ɑɟɯɿɹ) Lukmann Aet (ȿɫɬɨɧɿɹ)
Antunes Filipe (ɉɨɪɬɭɝɚɥɿɹ) Macfarlane John (ȱɪɥɚɧɞɿɹ)
Barotsis Nikolaos (Ƚɪɟɰɿɹ) Moslavac Saša (ɏɨɪɜɚɬɿɹ)
Berteanu Mihai (Ɋɭɦɭɧɿɹ) Munoz Susana (ȱɫɩɚɧɿɹ)
Borg Kristian (ɒɜɟɰɿɹ) Nikitina Annelii (ȿɫɬɨɧɿɹ)
Boyer François Constant (Ɏɪɚɧɰɿɹ) Nulle Anda (Ʌɚɬɜɿɹ)
Broholm Berit (Ⱦɚɧɿɹ) Oral Aydan (Ɍɭɪɟɱɱɢɧɚ)
Burger Helena (ɋɥɨɜɟɧɿɹ) Paternostro-Sluga Tatjana (Ⱥɜɫɬɪɿɹ)
Burn John PS (ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ) Petronic-Markovic Ivana (Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ)
Ceravolo Maria Gabriella (ȱɬɚɥɿɹ) Popa Daiana (Ɋɭɦɭɧɿɹ)
Christodoulou Nicolas (Ʉɿɩɪ) Roussos Nikolaos (Ƚɪɟɰɿɹ)
Delargy Mark (ȱɪɥɚɧɞɿɹ) Rudling Karin (ɒɜɟɰɿɹ)
Delarque Alain (Ɏɪɚɧɰɿɹ) Schwarzkopf Susanne (ɇɿɦɟɱɱɢɧɚ)
Denes Zoltan (ɍɝɨɪɳɢɧɚ) Sekelj-Kauzlariü Katarina (ɏɨɪɜɚɬɿɹ)
Fazekas Gabor (ɍɝɨɪɳɢɧɚ) Shostakiene Nijole (Ʌɢɬɜɚ)
Frischknecht Rolf (ɒɜɟɣɰɚɪɿɹ) Singh Rajiv K (ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ)
Golyk Volodymyr (ɍɤɪɚʀɧɚ) Stahl Minna (Ɏɿɧɥɹɧɞɿɹ)
Grabljevec Klemen (ɋɥɨɜɟɧɿɹ) Stam Henk J. (ɇɿɞɟɪɥɚɧɞɢ)
Hansen Birgitte (Ⱦɚɧɿɹ) Stanghelle Johan (ɇɨɪɜɟɝɿɹ)
Hornacek Karol (ɋɥɨɜɚɱɱɢɧɚ) Stefanovski Gordana (Ȼɨɫɧɿɹ ɬɚ Ƚɟɪɰɟɝɨɜɢɧɚ)
Ilieva Elena M. (Ȼɨɥɝɚɪɿɹ) Stemberger Regina (Ⱥɜɫɬɪɿɹ)
Irgens Ingeborg (ɇɨɪɜɟɝɿɹ) Sulaberidze Grigol (Ƚɪɭɡɿɹ)
Ivanova Galina Evgenia (Ɋɨɫɿɹ) Takáþ Peter (ɋɥɨɜɚɱɱɢɧɚ)
Janssen Wim G.M. (ɇɿɞɟɪɥɚɧɞɢ) Tederko Piotr (ɉɨɥɶɳɚ)
Juocevicius Alvydas (Ʌɢɬɜɚ) Valero Raquel (ȱɫɩɚɧɿɹ)
Kakulia Nelly (Ƚɪɭɡɿɹ) Vetra Anita (Ʌɚɬɜɿɹ)
Kankaanpaa Markku (Ɏɿɧɥɹɧɞɿɹ) Vladymyrov Oleksandr (ɍɤɪɚʀɧɚ)
Khasanova Dina (Ɋɨɫɿɹ) Votava Jiri (ɑɟɯɿɹ)
Kiekens Carlotte (Ȼɟɥɶɝɿɹ) Winkelmann Andreas (ɇɿɦɟɱɱɢɧɚ)
Küçükdeveci Ayúe A. (Ɍɭɪɟɱɱɢɧɚ) Zammit Stephen (Ɇɚɥɶɬɚ)
Kujawa Jolanta (ɉɨɥɶɳɚ) Zampolini Mauro (ȱɬɚɥɿɹ)
Lazoviü Milica (Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ)

36 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Äîäàòîê 3

Ñêîðî÷åííÿ

Í×ÌÒ (ABI) íàáóòà ÷åðåïíî-ìîçêîâà òðàâìà (Acquired Brain Injury)

AÐÌÑ Àìåðèêàíñüêà Ðàäà Ìåäè÷íèõ Ñïåö³àëüíîñòåé (American Board of Medical Specialties)
ÀÐÔÌÐ Àìåðèêàíñüêà Ðàäà ç Ô³çè÷íî¿ Ìåäèöèíè òà Ðåàá³ë³òàö³¿ (American Board of Physical Medicine and
Rehabilitation)
ÀÏÆ (ADL) àêòèâíîñò³ ïîâñÿêäåííîãî æèòòÿ (Activities of Daily Living)
APRM Annals of Physical and Rehabilitation Medicine (íàóêîâèé æóðíàë)
ÊÃÐ êîìàíäà ãîñòðî¿ ðåàá³ë³òàö³¿ (Acute Rehabilitation Team)
ÁÃÐ áëîê ãîñòðî¿ ðåàá³ë³òàö³¿ (Acute Rehabilitation Unit)
ÑÐÐ Ñîþç ðåàáèëèòîëîãîâ Ðîññèè
ASSIA Applied Social Science Index & Abstracts (Ðåôåðàòèâíèé êàòàëîã ðåçþìå ç ïðèêëàäíèõ ñîö³àëüíèõ íàóê)
BNF-PRM Baltic and North Sea Forum on Physical and Medical Rehabilitation (Ôîðóì ÔÐÌ Áàëò³éñüêîãî òà
ϳâí³÷íîãî ìîðÿ)
ÊÊÑ (CAC) Êîì³òåò êë³í³÷íèõ ñòîñóíê³â Ñåêö³¿ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè ªâðîïåéñüêîãî Ñîþçó
Ìåäè÷íèõ Ñïåö³àë³ñò³â
CARF Commission on Accreditation of Rehabilitation Facilities (Êîì³ñ³ÿ ç àêðåäèòàö³¿ ðåàá³ë³òàö³éíèõ çàêëàä³â)
ÐÍà (CBR) ðåàá³ë³òàö³ÿ, ùî íàäàºòüñÿ â ãðîìàä³ (Community Based Rehabilitation)
ÁÐÒ (CCU) áëîê ðåàí³ìàö³éíî¿ òåðàﳿ (Critical Care Unit)
ÏÐÃ (CDP) ïîë³òèêà ðîçâèòêó ãðîìàä (Community Development Policy)
CINAHL Cumulative Index to Nursing and Allied Health Literature (Êóìóëÿòèâíèé ³íäåêñ ë³òåðàòóðè ç ñåñòðèíñü-
êî¿ ñïðàâ³ ³ ñóì³æíèõ ïðîôåñ³é ç îõîðîíè çäîðîâ’ÿ)
ÁÌÎ (CME) áåçïåðåðâíà ìåäè÷íà îñâ³òà (Continuing Medical Education)
ÖÍÑ (CNS) öåíòðàëüíà íåðâîâà ñèñòåìà
COPE Committee on Publication Ethics (Êîì³òåò ç åòèêè ïóáë³êàö³é)
ÁÏÐ (CPD) áåçïåðåðâíèé ïðîôåñ³éíèé ðîçâèòîê (Continuing Professional Development)
Cr Clinical Rehabilitation (íàóêîâèé æóðíàë)
CRPD Êîíâåíö³ÿ ïðî ïðàâà îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ (Convention on The Rights of Persons With
Disabilities)
CST Classification. Terminology and Standards (Êëàñèô³êàö³ÿ. Òåðì³íîëîã³ÿ. Ñòàíäàðòè.)
ÐÆCÎÆ (DALYs) Ðîêè æèòòÿ, ñêîðèãîâàí³ ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ (Disability-Adjusted Life-Years)
ÎÆÐ (DAR) Îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà ðåàá³ë³òàö³ÿ (Disability and Rehabilitation)
EACCME European Accreditation Council of Continuing Medical Education (ªâðîïåéñüêà Ðàäà ç àêðåäèòàö³¿
áåçïåðåðâíî¿ ìåäè÷íî¿ îñâ³òè)
ªÀÐÌ (EARM) ªâðîïåéñüêà Àêàäåì³ÿ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (European Academy of Rehabilitation Medicine)
EBM Evidence Based Medicine(äîêàçîâà ìåäèöèíà)
ªÐÔÐÌ (EBPRM) ªâðîïåéñüêà Ðàäà Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (European Board of Physical and
Rehabilitation Medicine)
ªÊÁÌÎ (ECMEC) ºâðîïåéñüêèé êðåäèò áåçïåðåðâíî¿ ìåäè÷íî¿ îñâ³òè (European Continuing Medical Education Credit)
ªÊÔÐÌ (ECPRM) ªâðîïåéñüêèé Êîëåäæ Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (European College of Physical and
Rehabilitation Medicine)
ªÅÏ (EEA) ªâðîïåéñüêèé Åêîíîì³÷íèé Ïðîñò³ð (European Economic Area)
EFPRM ªâðîïåéñüêà Ôåäåðàö³ÿ Ô³çè÷íî¿ Ìåäèöèíè òà Ðåàá³ë³òàö³¿ (European Federation of Physical Medicine
and Rehabilitation)
EJPRM European Journal of Physical and Rehabilitation Medicine (íàóêîâèé æóðíàë)
EMRSS Euromediterranean Rehabilitation Summer School Haim Ring in Syracuse (ªâðî-ñåðåäçåìíîìîðñüêà
ë³òíÿ øêîëà Haim Ring ç ðåàá³ë³òàö³¿ â Ñèðàêóçàõ)
ÐÔÐ (EPR) ðàííÿ ô³çè÷íà ðåàá³ë³òàö³ÿ (Early Physical Rehabilitation)
ESM European School Marseille (ªâðîïåéñüêà øêîëà â Ìàðñåë³)
ªÒÔÐÌ (ESPRM) ªâðîïåéñüêå òîâàðèñòâî ç ÔÐÌ (European Society of PRM)
EÑ ªâðîïåéñüêèé Ñîþç
ÔÅÑ (FES) Ôóíêö³îíàëüíà Åëåêòðè÷íà Ñòèìóëÿö³ÿ (Functional Electrical Stimulation)
Fin Ô³íëÿíä³ÿ
FREDA Freedom, Respect, Equality, Dignity, Autonomy (Ñâîáîäà, Ïîâàãà, гâí³ñòü, óäí³ñòü, Àâòîíîì³ÿ)
ÂÂÏ Âàëîâèé Âíóòð³øí³é Ïðîäóêò
Ger ͳìå÷÷èíà
GMC(UK) UK General Medical Council (Ãåíåðàëüíà ìåäè÷íà ðàäà Âåëèêî¿ Áðèòàí³¿)
ÒÆÇ (HALE) Î÷³êóâàíà òðèâàë³ñòü æèòòÿ â çäîðîâîìó ñòàí³ (Healthy Life Expectancy)
IBECS Indice Bibliográfico Español en Ciencias de la Salud (²ñïàíñüêèé á³áë³îãðàô³÷íèé ³íäåêñ ç ìåäè÷íèõ
íàóê)
ÌÊÕ Ì³æíàðîäíà êëàñèô³êàö³ÿ õâîðîá. Ðîçðîáëåíà Âñåñâ³òíüîþ îðãàí³çàö³ºþ îõîðîíè çäîðîâ’ÿ
ÌÊÔ Ì³æíàðîäíà êëàñèô³êàö³ÿ ôóíêö³îíóâàííÿ, îáìåæåíü æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 37
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

ICHI International Classification of Health Interventions (̳æíàðîäíà êëàñèô³êàö³ÿ âòðó÷àíü â îõîðîí³

çäîðîâ’ÿ)
ÌÊÏ Ì³æíàðîäíà êëàñèô³êàö³ÿ ïîðóøåíü, îáìåæåíü æèòòºä³ÿëüíîñò³ òà ñîö³àëüíî¿ íåäîñòàòíîñò³. Ðîçðîá-
ëåíà Âñåñâ³òíüîþ îðãàí³çàö³ºþ îõîðîíè çäîðîâ’ÿ
ICSO-R International Classification of Service Organisations For Rehabilitation (̳æíàðîäíà êëàñèô³êàö³ÿ
îðãàí³çàö³¿ ïîñëóã äëÿ ðåàá³ë³òàö³¿)
²ÊÒ ³íôîðìàö³éí³ òà êîìóí³êàö³éí³ òåõíîëî㳿
Á²Ò (ICU) áëîê ³íòåíñèâíî¿ òåðàﳿ (Intensive Care Unit)
IJRR International Journal of Rehabilitation Research (íàóêîâèé æóðíàë)
Insci International Survey on Spinal Cord Injury (̳æíàðîäíå äîñë³äæåííÿ òðàâì ñïèííîãî ìîçêó)
INSERM French National Institute For Health and Medical Research (Ôðàíöóçüêèé Íàö³îíàëüíèé ²íñòèòóò
Çäîðîâ’ÿ òà Ìåäè÷íèõ Äîñë³äæåíü)
ISPRM ̳æíàðîäíå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (International Society of PRM)
JPRM Journal of Physical and Rehabilitation Medicine (íàóêîâèé æóðíàë)
JRM Journal of Rehabilitation Medicine (íàóêîâèé æóðíàë)
ÒÏ (LOS) òðèâàë³ñòü ïåðåáóâàííÿ (Length of Stay)
Madr Ìàäðèä
MCQ ïèòàííÿ ç ìíîæèííèì âèáîðîì (Multiple Choice Questions)
MFPRM Mediterranean Forum of Physical and Rehabilitation Medicine (Ñåðåäçåìíîìîðñüêèé ôîðóì ç ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè)
ÍÄÎ íåäåðæàâíà îðãàí³çàö³ÿ
ÍÌÅÑ (NMES) íåéðî- ì’ÿçîâà åëåêòðè÷íà ñòèìóëÿö³ÿ (Neuro-Muscular Electrical Stimulation)
ÅÒ (ÎÒ) Åðãîòåðàï³ÿ / Åðãîòåðàïåâò (Occupational Therapy/Occupational Therapist)
PhD äîêòîð ô³ëîñîô³¿
ÊÏÏ (PPC) Êîì³òåò ïðîôåñ³éíî¿ ïðàêòèêè Ñåêö³¿ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè ªâðîïåéñüêîãî Ñîþçó
Ìåäè÷íèõ Ñïåö³àë³ñò³â
ËÐ ëåãåíåâà ðåàá³ë³òàö³ÿ (Pulmonary Rehabilitation)
ÔÐÌ Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà
ÔÒ (PT) Ô³çè÷íà òåðàï³ÿ (Physical Therapy)
ßÆ (QoL) ÿê³ñòü æèòòÿ (Quality of Life)
RAT Rehabilitation Advisory Team (Êîíñóëüòàòèâíà ãðóïà ç ðåàá³ë³òàö³¿)
ÐÊÄ ðàíäîì³çîâàíå êîíòðîëüîâàíå äîñë³äæåííÿ
RFO European Research Funding Organizations (ºâðîïåéñüê³ îðãàí³çàö³¿, ÿê³ ô³íàíñóþòü äîñë³äæåííÿ)
RM Rehabilitación (Madr.) (íàóêîâèé æóðíàë)
RPO Research Performing Organizations (îðãàí³çàö³¿, ùî âèêîíóþòü äîñë³äæåííÿ)
ÒÌÌ (SALT) Òåðàï³ÿ ìîâè òà ìîâëåííÿ (Speech and Language Therapy)
ÑÌÒ (SCI) ñïèííîìîçêîâà òðàâìà (Spinal Cord Injury)
Sco Øîòëàíä³ÿ
SERMEF Sociedad Española de Rehabilitación y Medicina Física (²ñïàíñüêå òîâàðèñòâî ðåàá³ë³òàö³¿ òà ô³çè÷íî¿
ìåäèöèíè)
SIMFER Società Italiana di Medicina Fisica e Riabilitazione
Slo Ñëîâåí³ÿ
ÒÌÌ (SALT) Òåðàï³ÿ ìîâè òà ìîâëåííÿ / Òåðàïåâò ìîâè òà ìîâëåííÿ (Speech and Language Therapy / Speech and
Language Therapist)
SPA “Salus Per Aquam”. (Çäîðîâ’ÿ ÷åðåç âîäó)
Swisci Swiss Spinal Cord Injury Cohort Study (Øâåéöàðñüêå êîãîðòíå äîñë³äæåííÿ ñïèííîìîçêîâî¿ òðàâìè)
×ÌÒ (TBI) ÷åðåïíî-ìîçêîâà òðàâìà (Traumatic Brain Injury)
TENS ÷åðåçøê³ðíà åëåêòðîñòèìóëÿö³ÿ íåðâó (Transcutaneous Electrical Nerve Stimulation)
ÒÌÑ (TMS) òðàíñêðàí³àëüíà ìàãí³òíà ñòèìóëÿö³ÿ (Transcranial Magnetic Stimulation)
ªÑÌÑ (UEMS) ªâðîïåéñüêèé Ñîþç Ìåäè÷íèõ Ñïåö³àë³ñò³â (Union Européenne Des Médecins Spécialistes – European
Union of Medical Specialists)
ÎÎÍ Îðãàí³çàö³ÿ Îá’ºäíàíèõ Íàö³é
UNCRPD Êîíâåíö³ÿ ïðî ïðàâà îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ ÎÎÍ (United Nations Convention on Rights
of Persons With Disabilities)
ÓÔ Óëüòðàô³îëåòîâå (âèïðîì³íþâàííÿ)
ÏÐ (VR) ïðîôåñ³éíà ðåàá³ë³òàö³ÿ (Vocational Rehabilitation)
ÁÊ (WB) Á³ëà Êíèãà ç ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè â ªâðîï³ (White Book of Physical and Rehabilitation
Medicine in Europe)
ÂÎÎÇ Âñåñâ³òíÿ Îðãàí³çàö³ÿ Îõîðîíè Çäîðîâ’ÿ
ÂÄÎÆ (WRD) Âñåñâ³òíÿ äîïîâ³äü ç îáìåæåíü æèòòºä³ÿëüíîñò³ (World Report on Disability)

38 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐM) â ªâðîï³
Ðîçä³ë 1 – Âèçíà÷åííÿ òà ïîíÿòòÿ ÔÐÌ
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
 êîíòåêñò³ Á³ëî¿ êíèãè Ô³çè÷íî¿ ³ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ) â ªâðîï³, öåé äîêóìåíò çàéìàºòüñÿ âèçíà÷åííÿìè
òà ïîíÿòòÿìè, ùî ìàþòü â³äíîøåííÿ äî ÔÐÌ. Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà – öå ïåðâèííà ìåäè÷íà ñïåö³àëüí³ñòü,
ÿêà â³äïîâ³äຠçà ïðîô³ëàêòèêó, ìåäè÷íó ä³àãíîñòèêó, ë³êóâàííÿ òà óïðàâë³ííÿ ðåàá³ë³òàö³ºþ îñ³á óñ³õ â³êîâèõ ãðóï ç³
ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³ òà ¿õ êîìîðá³äíèõ ñòàí³â òà ïðèä³ëÿº îñîáëèâó óâàãó ¿õ
ïîðóøåííÿì ³ îáìåæåííÿì àêòèâíîñò³ ç ìåòîþ ñïðèÿííÿ ¿¿ ô³çè÷íîìó ³ êîãí³òèâíîìó ôóíêö³îíóâàííþ (âêëþ÷àþ÷è
ïîâåä³íêó), ó÷àñò³ (âêëþ÷àþ÷è ÿê³ñòü æèòòÿ) ³ ìîäèô³êàö³¿ îñîáèñòèõ ôàêòîð³â òà ôàêòîð³â ñåðåäîâèùà.
Äëÿ òîãî, ùîá ïðèéòè äî öüîãî âèçíà÷åííÿ ÔÐM, ìè ïîâèíí³ ðîçãëÿíóòè éîãî êîíöåïòóàëüíèé îïèñ. Íåîáõ³äíî â³äçíà-
÷èòè ê³ëüêà ôóíäàìåíòàëüíèõ àñïåêò³â, çîêðåìà: ôóíêö³îíóâàííÿ, îáìåæåííÿ æèòòºä³ÿëüíîñò³ ³ ðåàá³ë³òàö³þ.
Ö³ âèçíà÷åííÿ âêëþ÷åí³ äî òà ïðåäñòàâëåí³ â ö³é ãëàâ³:
– Ôóíêö³îíóâàííÿ: âñå, ùî ðîáëÿòü ëþäñüê³ ò³ëà, ³ 䳿, ÿê³ âèêîíóþòü ëþäè. Ó Ì³æíàðîäí³é êëàñèô³êàö³¿ ôóíêö³îíó-
âàííÿ, îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ) ôóíêö³îíóâàííÿ ïðåäñòàâëåíî â òåðì³íàõ ôóíêö³îíàëüíèõ
äîìåí³â òà ö³ äîìåíè ðîçä³ëåí³ íà âèì³ðè Ôóíêö³é òà Ñòðóêòóð Îðãàí³çìó, Àêòèâíîñò³ òà Ó÷àñò³;
– Îáìåæåííÿ æèòòºä³ÿëüíîñò³ – ïðîáëåìà îñîáè, ùî âèêîíóº 䳿, ÿê³ â³í àáî âîíà ïîòðåáóº àáî õî÷å âèêîíàòè, ÿêà
âèíèêຠâíàñë³äîê îñíîâíîãî ñòàíó çäîðîâ’ÿ, – çàõâîðþâàííÿ, òðàâìè àáî, íàâ³òü, ñòàð³ííÿ – ³ ÿêà âïëèâຠíà éîãî
àáî ¿¿ âèêîíàííÿ â éîãî àáî ¿¿ ðåàëüíîìó ñåðåäîâèùàõ.
– Ðåàá³ë³òàö³ÿ: êîìïëåêñ çàõîä³â, ÿê³ äîïîìàãàþòü ëþäÿì, ÿê³ çàçíàëè, àáî ìîæóòü çàçíàòè îáìåæåíü æèòòºä³ÿëüíîñò³,
äîñÿãòè ³ ï³äòðèìóâàòè îïòèìàëüíå ôóíêö³îíóâàííÿ ó âçàºìî䳿 ç³ ñâî¿ìè ñåðåäîâèùàìè.
Âèçíà÷åííÿ îáìåæåííÿ æèòòºä³ÿëüíîñò³ çà ÌÊÔ ÷³òêî ðîçð³çíÿº ïðîáëåìè, ÿê³ ïîâí³ñòþ º ðåçóëüòàòîì îñíîâíîãî
ñòàíó çäîðîâ’ÿ (çäàòí³ñòü) â³ä ïðîáëåì, ùî âèíèêàþòü âíàñë³äîê âçàºìî䳿 çäàòíîñò³ òà ôàêòîð³â ñåðåäîâèùà ³ îñîáèñ-
òèõ ôàêòîð³â (âèêîíàííÿ).
Öåé äîêóìåíò ñòîñóºòüñÿ âñ³õ öèõ êîíöåïö³é, ÿê³ º ñóòòºâèìè äëÿ ðîçóì³ííÿ ñòðàòå㳿 ÔÐÌ ç îö³íêè îáìåæåíü æèòòº-
ä³ÿëüíîñò³ òà çä³éñíåííÿ âòðó÷àíü, ÿê³ ìîæóòü ïðèçâåñòè äî ïîë³ïøåííÿ ôóíêö³îíóâàííÿ òà çäîðîâ’ÿ.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 1. Definitions and concepts of PRM. Eur J Phys Rehabil
Med. 2018 Apr;54(2):156-165.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 1. Âèçíà÷åííÿ òà ïîíÿòòÿ ÔÐÌ. Óêðà¿íñüêèé
æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 39–48
Êëþ÷îâ³ ñëîâà: Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà, ªâðîïà, Îáìåæåííÿ Æèòòºä³ÿëüíîñò³, Ôóíêö³îíóâàííÿ, Ðåàá³-
ë³òàö³ÿ.

Ââåäåííÿ
Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî
óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³î-
íàëüíîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòå-
ð³àë³â äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìó-
âàííÿ ïðî ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â
ðåàá³ë³òàö³¿ òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà
âàæëèâîñò³ ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ ñïåö³-
àëüí³ñòþ. Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïîíÿòòÿ
ÔÐÌ, ÷îìó ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì ëþäÿì
³ ñóñï³ëüñòâó, îñíîâè ÔÐÌ, ³ñòîð³ÿ ñïåö³àëüíîñò³
ÔÐÌ, ñòðóêòóðà ³ ä³ÿëüí³ñòü îðãàí³çàö³é ÔÐÌ
â ªâðîï³, çíàííÿ ³ íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà
êë³í³÷íèõ êîìïåòåíòíîñòåé ÔÐÌ, ì³ñöå ñïåö³-
àëüíîñò³ ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ ³
ñóñï³ëüñòâ³, îñâ³òà òà áåçïåðåðâíèé ïðîôåñ³éíèé
ðîçâèòîê ë³êàð³â ÔÐÌ, îñîáëèâîñò³ òà ïðîáëåìè
íàóêè òà äîñë³äæåíü â ÔÐÌ òà ïðîáëåìè òà ïåð-
ñïåêòèâè ìàéáóòíüîãî ÔÐÌ.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 39
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà – öå ïåð-
âèííà ìåäè÷íà ñïåö³àëüí³ñòü, ÿêà â³äïîâ³äຠçà
ïðîô³ëàêòèêó, ìåäè÷íó ä³àãíîñòèêó, ë³êóâàííÿ òà
óïðàâë³ííÿ ðåàá³ë³òàö³ºþ îñ³á óñ³õ â³êîâèõ ãðóï ç³
ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâîäÿòü äî îáìåæåíü
æèòòºä³ÿëüíîñò³ òà ¿õ êîìîðá³äíèõ ñòàí³â òà ïðè-
ä³ëÿº îñîáëèâó óâàãó – ïîðóøåííÿì ³ îáìåæåííÿì
àêòèâíîñò³ ç ìåòîþ ñïðèÿííÿ ¿õ ô³çè÷íîìó ³ êîãí-
³òèâíîìó ôóíêö³îíóâàííþ (âêëþ÷àþ÷è ïîâåä³íêó),
ó÷àñò³ (âêëþ÷àþ÷è ÿê³ñòü æèòòÿ) ³ ìîäèô³êàö³¿
îñîáèñòèõ ôàêòîð³â òà ôàêòîð³â ñåðåäîâèùà.
Äëÿ òîãî, ùîá ïðèéòè äî öüîãî âèçíà÷åííÿ ÔÐM,
ìè ïîâèíí³ ðîçãëÿíóòè éîãî êîíöåïòóàëüíèé îïèñ.
Íåîáõ³äíî â³äçíà÷èòè ê³ëüêà ôóíäàìåíòàëüíèõ
àñïåêò³â, çîêðåìà: ôóíêö³îíóâàííÿ, îáìåæåííÿ
æèòòºä³ÿëüíîñò³ ³ ðåàá³ë³òàö³þ.
Ö³ âèçíà÷åííÿ âêëþ÷åí³ äî òà ïðåäñòàâëåí³ â ö³é
ãëàâ³:
– Ôóíêö³îíóâàííÿ: âñå, ùî ðîáëÿòü ëþäñüê³ ò³ëà,
³ 䳿, ÿê³ âèêîíóþòü ëþäè. Ó Ì³æíàðîäí³é êëà-
ñèô³êàö³¿ ôóíêö³îíóâàííÿ, îáìåæåííÿ æèòòºä³-
ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ) ôóíêö³îíóâàííÿ
ïðåäñòàâëåíî â òåðì³íàõ ôóíêö³îíàëüíèõ äî-
ìåí³â òà ö³ äîìåíè ðîçä³ëåí³ íà âèì³ðè Ôóíêö³é
òà Ñòðóêòóð Îðãàí³çìó, Àêòèâíîñò³ òà Ó÷àñò³;
– Îáìåæåííÿ æèòòºä³ÿëüíîñò³ – ïðîáëåìà îñîáè,
ùî âèêîíóº 䳿, ÿê³ â³í àáî âîíà ïîòðåáóº àáî
õî÷å âèêîíàòè, ÿêà âèíèêຠâíàñë³äîê îñíîâíî-
ãî ñòàíó çäîðîâ’ÿ, – çàõâîðþâàííÿ, òðàâìè àáî,
íàâ³òü, ñòàð³ííÿ – ³ ÿêà âïëèâຠíà éîãî àáî ¿¿ âè-
êîíàííÿ â éîãî àáî ¿¿ ðåàëüíîìó ñåðåäîâèùàõ.
– Ðåàá³ë³òàö³ÿ: êîìïëåêñ çàõîä³â, ÿê³ äîïîìàãà-
þòü ëþäÿì, ÿê³ çàçíàëè, àáî ìîæóòü çàçíàòè
îáìåæåíü æèòòºä³ÿëüíîñò³, äîñÿãòè ³ ï³äòðèìó-
âàòè îïòèìàëüíå ôóíêö³îíóâàííÿ ó âçàºìî䳿 ç³
ñâî¿ìè ñåðåäîâèùàìè.
Ôóíêö³îíóâàííÿ
Ôóíêö³îíóâàííÿ, äîâ³äêîâà ³íôîðìàö³ÿ ÂÎÎÇ
Ç ìîìåíòó ñâîãî çàñíóâàííÿ â 1948 ðîö³ ìàí-
äàò ÂÎÎÇ ïîëÿãàâ â òîìó, ùîá äîñÿãòè «çàäîâî-
ëåííÿ íàéâèùèì äîñÿæíèì ñòàíäàðòîì çäîðîâ’ÿ,
ÿê ôóíäàìåíòàëüíîãî ïðàâà êîæíî¿ ëþäèíè», â
ÿêîìó çäîðîâ’ÿ âèçíà÷àºòüñÿ ÿê «… ñòàí ïîâíîãî
ô³çè÷íîãî, ïñèõ³÷íîãî ³ ñîö³àëüíîãî áëàãîïîëó÷÷ÿ,
à íå ëèøå â³äñóòí³ñòü õâîðîáè ³ íåäóã»1.
Äëÿ êîíòðîëþ öüîãî ïðàãíåííÿ, ÂÎÎÇ ðåãóëÿð-
íî îíîâëþº ̳æíàðîäíó êëàñèô³êàö³þ õâîðîá
(ÌÊÕ), ÿê óí³âåðñàëüíó äîâ³äêîâó ñèñòåìó äëÿ ðåº-
ñòðàö³¿ ñìåðòíîñò³ òà çàõâîðþâàíîñò³2. ¯¿ îñòàííÿ
âåðñ³ÿ, ÌÊÕ XI, òàêîæ äîçâîëèòü îïèñàòè ÿê á³î-
ìåäè÷íèé õàðàêòåð, òàê ³ âïëèâ ñòàí³â çäîðîâ’ÿ3.
Ó 2001 ðîö³ Âñåñâ³òíÿ àñàìáëåÿ îõîðîíè çäî-
ðîâ’ÿ ñõâàëèëà ̳æíàðîäíó êëàñèô³êàö³þ ôóíê-
40 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ö³îíóâàííÿ, îáìåæåíü æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ
(ÌÊÔ)4, ç ìåòîþ îïåðàö³îíàë³çóâàííÿ ÿê á³îìåäè÷-
íî¿ ïðèðîäè ñòàí³â çäîðîâ’ÿ – ôóíêö³é òà ñòðóêòóð
îðãàí³çìó òà ¿õ ïîðóøåíü – òàê ³ çàãàëüíîãî âïëè-
âó íà æèòòºâèé äîñâ³ä çäîðîâ’ÿ îñîáè ó âçàºìî䳿
ç ¿¿ ñåðåäîâèùåì. ÌÊÔ çàáåçïå÷óº êëàñèô³êàö³þ
òà ñòàíäàðòíó ì³æíàðîäíó çàãàëüíó ìîâó, â òåð-
ì³íàõ ÿêî¿ æèòòºâèé äîñâ³ä çäîðîâ’ÿ ìîæå áóòè
îïåðàö³îíàë³çîâàíèì íà ³íäèâ³äóàëüíîìó òà ïîïó-
ëÿö³éíîìó ð³âíÿõ.  ÌÊÔ á³îìåäè÷íà ïðèðîäà òà
çàãàëüíèé âïëèâ ñòàí³â çäîðîâ’ÿ â êîíòåêñò³ æèò-
òÿ ëþäåé, áåðó÷è äî óâàãè ñåðåäîâèùå, â ÿêîìó
âîíè æèâóòü, òà ¿õ îñîáèñò³ ôàêòîðè, ³ íàçèâàºòü-
ñÿ ôóíêö³îíóâàííÿì.
ÌÊÔ º ì³æíàðîäíîþ êëàñèô³êàö³ºþ çäîðîâ’ÿ òà
ôóíêö³îíóâàííÿ; öå òàêîæ ³íôîðìàö³éíà äîâ³äêîâà
ñèñòåìà äëÿ ñòàíäàðòèçîâàíîãî îïèñó çäîðîâ’ÿ,
ôóíêö³îíóâàííÿ òà îáìåæåíü æèòòºä³ÿëüíîñò³ íà
âñ³õ ð³âíÿõ îõîðîíè çäîðîâ’ÿ òà ïîâ’ÿçàíèõ ñèñòåì,
âêëþ÷àþ÷è ñîö³àëüí³, îñâ³òí³ òà òðóäîâ³. ÌÊÔ º
çíà÷óùîþ òà êîðèñíîþ äëÿ ïðàêòèêóþ÷èõ
ôàõ³âö³â, ÿê³ ïðàãíóòü îïòèì³çóâàòè ôóíêö³îíóâàí-
íÿ îêðåìèõ ïàö³ºíò³â, ïîë³òèê³â, ÿê³ ïðàãíóòü ôîð-
ìóâàòè ñèñòåìó îõîðîíè çäîðîâ’ÿ â³äïîâ³äíî äî
âèìîã ³ ïîòðåá ôóíêö³îíóâàííÿ ëþäåé, òà äëÿ äîñ-
ë³äíèê³â, ÿê³ ïðàãíóòü ïîÿñíèòè òà âïëèâàòè íà
ôóíêö³îíóâàííÿ, à òàêîæ íàóê òà ïðîôåñ³é ç ôóíê-
ö³îíóâàííÿ5.
Ôóíêö³îíóâàííÿ, îïåðàö³îíàë³çàö³ÿ çäîðîâ’ÿ
ÂÎÎÇ
“Ôóíêö³îíóâàííÿ” º öåíòðàëüíîþ êîíöåïö³ºþ
ÌÊÔ ³ ïîçíà÷ຠïîâíèé íàá³ð ôóíêö³é òà ñòðóêòóð
îðãàí³çìó ëþäèíè, à òàêîæ óñ³õ ä³é ëþäèíè, ïðî-
ñòèõ ³ ñêëàäíèõ (Ìàëþíîê 1).
Ñòèñëî, ôóíêö³îíóâàííÿ – öå âñå, ùî ðîáëÿòü
ëþäñüê³ ò³ëà, ³ âñ³ 䳿, ÿê³ âèêîíóþòü ëþäè. Ó ÌÊÔ
Ìàëþíîê 1. Ñòðóêòóðà ôóíêö³îíóâàííÿ òà îáìåæåíü æèò-
òºä³ÿëüíîñò³ â ̳æíàðîäí³é êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ,
îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ.
¹2(2) *2018

ôóíêö³îíóâàííÿ âèçíà÷åíî â òåðì³íàõ äîìåí³â ôóí-
êö³îíóâàííÿ, ³ ö³ äîìåíè ðîçä³ëåí³ íà âèì³ðè
Ôóíêö³é òà Ñòðóêòóð Îðãàí³çìó, Àêòèâíîñò³ òà
Ó÷àñò³. Âîíè äàë³ îðãàí³çîâóþòüñÿ â òåðì³íàõ
ñïåêòðó â³ä ïðîñòîãî äî ñêëàäíîãî, â³ä îñíîâíèõ
ôóíêö³é îðãàí³çìó, òàêèõ, ÿê ç³ð, äî äóæå ñêëàäíèõ
òà ñîö³àëüíî âèçíà÷åíèõ ñôåð ó÷àñò³, òàêèõ ÿê ðî-
áîòà àáî ó÷àñòü ó æèòò³ ãðîìàäè. ßê êëàñèô³êà-
ö³ÿ, ÌÊÔ ïðèçíà÷åíà äëÿ òîãî, ùîá áóòè âñåîñÿæ-
íîþ, àëå ãíó÷êîþ, çàáåçïå÷óþ÷è êë³í³öèñòà àáî
äîñë³äíèêà ïîâíîþ ìîâîþ ôóíêö³îíóâàííÿ, îäíî-
÷àñíî äîçâîëÿþ÷è ðîçøèðåííÿ ÷åðåç ñïåöèô³êàö³¿
äîäàòêîâèõ äîìåí³â, çà ïîòðåáè.
Êîæåí ç äîìåí³â ôóíêö³îíóâàííÿ ÌÊÔ ðîçãëÿ-
äàºòüñÿ ÿê êîíòèíóóì, â³ä ïîâíî¿ â³äñóòíîñò³ ôóí-
êö³îíóâàííÿ äî ïîâíîãî ôóíêö³îíóâàííÿ. Ó ïåâíèé
ìîìåíò ÷àñó ð³âåíü ôóíêö³îíóâàííÿ êîæíî¿ îñîáè
â êîæíîìó äîìåí³ ìîæå, â ïðèíöèï³, áóòè îïèñà-
íèì, ³, â çàëåæíîñò³ â³ä çàïëàíîâàíîãî äîñë³äæåí-
íÿ àáî êë³í³÷íîãî ïðèçíà÷åííÿ äëÿ öüîãî, ìîæå
áóòè îïèñàíèé òàêîæ âñåá³÷íèé ïîðòðåò çàãàëüíîãî
ôóíêö³îíóâàííÿ ëþäèíè â ðîçð³ç³ ÷àñó. Á³ëüø òîãî,
îñê³ëüêè çàãàëüíå ôóíêö³îíóâàííÿ ëþäèíè áóäå
áåçïåðåðâíî çì³íþâàòèñÿ ïðîòÿãîì óñüîãî æèòòÿ,
ÌÊÔ òàêîæ çàáåçïå÷óº äîâ³äêîâó ìîâó äëÿ îïè-
ñó ïðîòÿãîì òðèâàëîãî ïåð³îäó. Ó òîé ÷àñ, ÿê ôóí-
êö³îíóâàííÿ çá³ëüøóºòüñÿ â ðîêè ðàííüîãî æèòòÿ
ëþäèíè, âîíî áóäå ïîò³ì çìåíøóâàòèñÿ âíàñë³äîê
òðàâì ³ õâîðîá ³, çðåøòîþ, ç³ ñòàð³ííÿì. Òàêèì
÷èíîì, ïðè íàÿâíîñò³ äîñòàòí³õ ïîïóëÿö³éíèõ äà-
íèõ ìîæíà ñòâîðèòè ðåïðåçåíòàòèâí³ òðàºêòîð³¿
ñòàð³ííÿ, â ñâ³òë³ âèíèêíåííÿ ñïåöèô³÷íèõ ñòàí³â
çäîðîâ’ÿ òà êîìîðá³äíîñòåé, â ìåæàõ ÿêèõ ìîæíà
îïèñàòè, àáî ïåðåäáà÷èòè ïîòåíö³éíèé âïëèâ íà
ôóíêö³îíóâàííÿ êë³í³÷íèõ ³ ïîïóëÿö³éíèõ âòðó÷àíü.
Ïðàêòè÷í³ ³íñòðóìåíòè äëÿ ³ìïëåìåíòàö³¿
ÌÊÔ â êë³í³÷íó ïðàêòèêó, íàäàííÿ òà îïëàòó
ïîñëóã, ïîë³òèêó ³ äîñë³äæåííÿ
Ïðàêòè÷í³ ³íñòðóìåíòè, ùî äîïîìàãàþòü çàñ-
òîñóâàííþ ÌÊÔ äëÿ øèðîêîãî êîëà ö³ëåé – ³íñòðó-
ìåíò äëÿ çáîðó êë³í³÷íèõ äàíèõ òà ³íñòðóìåíò
çâ³òíîñò³ íà îñíîâ³ ÌÊÔ5,6. ÌÊÔ º êëàñèô³êàö³ºþ,
òîìó äëÿ ¿¿ âèêîðèñòàííÿ íàì ïîòð³áí³ ð³çí³ ³íñòðó-
ìåíòè, ÿê³ ïðîñóíóòü êëàñèô³êàö³þ äî ïðàêòèêè. Ö³
³íñòðóìåíòè äîçâîëÿþòü íàì âèçíà÷èòè, ÿê³ äîìå-
íè ôóíêö³îíóâàííÿ ìè õî÷åìî äîêóìåíòóâàòè;
äàþòü ìîæëèâ³ñòü çáèðàòè äàí³ ïðî ôóíêö³îíóâàí-
íÿ ïîñë³äîâíî, íà êë³í³÷íîìó àáî ïîïóëÿö³éíîìó
ð³âí³; ³ äîçâîëÿþòü çâ³òóâàòè ïðî äàí³, ç³áðàí³ ç
âèêîðèñòàííÿì çàãàëüíî¿ ìåòðèêè, ùî äîçâîëÿº
ïðîâåñòè äîñòîâ³ðíå ïîð³âíÿííÿ äàíèõ ïðî ôóíêö-
³îíóâàííÿ, ç³áðàíèõ ç ð³çíèõ äæåðåë (Ìàëþíîê 2).
³äïîâ³äíî, ïðè ïëàíóâàíí³ çáîðó êë³í³÷íèõ äàíèõ,
äëÿ ïðîâåäåííÿ äîñë³äæåíü àáî äëÿ çâ³òóâàííÿ ïðî
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 1 – ÂÈÇÍÀ×ÅÍÍß ÒÀ ÏÎÍßÒÒß ÔÐÌ
âæå ç³áðàí³ äàí³, êîðèñòóâà÷àì ÌÊÔ íåîáõ³äíî
ïîñòàâèòè ñîá³ ÷îòèðè íàñòóïí³ ïèòàííÿ ùîäî ôóí-
êö³îíóâàííÿ7,8:
– ßê³ äîìåíè ÌÊÔ ìè õî÷åìî äîêóìåíòóâàòè?
(íàïð. âèêîðèñòîâóþ÷è Çàãàëüíèé íàá³ð ÌÊÔ,
Ðåàá³ë³òàö³éíèé íàá³ð ÌÊÔ àáî Áàçîâèé íàá³ð
ÌÊÔ äëÿ ïåâíîãî ñòàíó çäîðîâ’ÿ, ïðîòÿãîì
êîíòèíóóìó äîïîìîãè, àáî â êîíòåêñò³, íàïðèê-
ëàä, ÿê ïðîôåñ³éíà ðåàá³ë³òàö³ÿ)9-12.
– ßêó ïåðñïåêòèâó ìè áàæàºìî îõîïèòè? (íàïð.
çäàòí³ñòü àáî âèêîíàííÿ)?
– ßê³ ³íñòðóìåíòè çáîðó äàíèõ çàñòîñîâóâàòè-
ìóòüñÿ äî íàøî¿ ìåòè?
– ßêèé ìåòðè÷íèé ï³äõ³ä ìè õî÷åìî âèêîðèñòî-
âóâàòè äëÿ çâ³òóâàííÿ?
ÌÊÔ òà ôóíêö³îíóâàííÿ â ðåàá³ë³òàö³¿
ÌÊÔ º ôóíäàìåíòàëüíîþ äëÿ ðåàá³ë³òàö³¿, ï’ÿ-
òî¿ ñòðàòåã³ÿ îõîðîíè çäîðîâ’ÿ ðàçîì ³ç ë³êóâàëü-
íîþ, ï³äòðèìóþ÷îþ, ïðîô³ëàêòè÷íîþ ³ ïàë³àòèâ-
íîþ 13-15 . ÌÊÔ òàêîæ º ôóíäàìåíòàëüíîþ äëÿ
ñôåðè ÔÐÌ, ÿêó ä³éñíî ìîæíà íàçâàòè ìåäèöèíîþ
ôóíêö³îíóâàííÿ5,14,15. Öå òîìó, ùî çàãàëüíîþ ìå-
òîþ ÿê ðåàá³ë³òàö³¿, òàê ³ ÔÐÌ º îïòèì³çàö³ÿ ôóíê-
ö³îíóâàííÿ îñîáè ³, òèì ñàìèì, ï³äâèùåííÿ éîãî
àáî ¿¿ ÿêîñò³ æèòòÿ16. ÔÐÌ äîñÿãຠöüîãî øëÿõîì
îïòèì³çàö³¿ çà äîïîìîãîþ ë³êóâàííÿ âíóòð³øí³õ
àñïåêò³â çäîðîâ’ÿ ç ôóíêö³îíóâàííÿ, àáî «çäàò-
íîñò³» â òåðì³íàõ ÌÊÔ, àáî çà äîïîìîãîþ óìîæ-
ëèâëåííÿ çì³í éîãî àáî ¿¿ ñåðåäîâèùà äëÿ îïòèì³-
çàö³¿ ôàêòè÷íîãî âèêîíàííÿ ôóíêö³îíóâàííÿ îñîáè.
Ö³ âòðó÷àííÿ óñï³øí³ ò³ëüêè òîä³, êîëè âîíè ñïðÿ-
ìîâàí³ íà âçàºìîä³þ ì³æ ñòàíîì çäîðîâ’ÿ ³ ôàê-
òîðàìè ñåðåäîâèùà, îñê³ëüêè ò³ëüêè òîä³ âòðó÷àí-
Ìàëþíîê 2. Äåìîíñòðàö³ÿ ôóíêö³îíàëüíîãî ïðîô³ëþ äëÿ ïî-
ïóëÿö³¿ Øâåéöàðñüêîãî êîãîðòíîãî äîñë³äæåííÿ óðàæåíü
ñïèííîãî ìîçêó (SwiSCI).
41
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Òàáëèöÿ IÀ. Ôóíêö³îíàëüí³ ïðîô³ë³. Ïðîô³ëü êàòåãîð³é ÌÊÔ; êè çîðó ¿¿ îñíîâíî¿ êîíöåïòóàëüíî¿ ìîäåë³ ôóíêö³î-
Êâàë³ô³êàòîð ÌÊÔ: îö³íþº ìàñøòàá ïðîáëåì (â³ä 0 = íåìຠíóâàííÿ, òàê ³ á³ëüø ïðàêòè÷íî, íà ¿¿ êëàñèô³êàö³¿,
ïðîáëåìè äî 4 = ïîâíà ïðîáëåìà) â êîìïîíåíòàõ ôóíêö³é
îðãàí³çìó (b), ñòðóêòóð îðãàí³çìó (s), àêòèâíîñò³ òà ó÷àñò³ ÿê³ ìîæóòü áóòè âèêîðèñòàí³ äëÿ çàáåçïå÷åííÿ
(d); Âçàºìîçâ’ÿçîê ç ö³ëÿìè: 1 ³ 2 â³äíîñÿòüñÿ äî ö³ëåé Öèêëó 1 ïîð³âíÿííîñò³ ç³áðàíèõ òà ïðåäñòàâëåíèõ äàíèõ.
³ 2. ÏÄ â³äíîñèòüñÿ äî ö³ë³ Ïðîãðàìè äîïîìîãè; çíà÷åííÿ Ö³ë³ ÌÊÔ ìîæëèâî çàñòîñóâàòè â îïèñ³ îêðåìèõ
â³äíîñèòüñÿ äî êâàë³ô³êàòîðó ÌÊÔ, äëÿ äîñÿãíåííÿ ï³ñëÿ ïàö³ºíò³â17 (Òàáëèöÿ ²), à òàêîæ ïîïóëÿö³é (Ìàëþ-
âòðó÷àííÿ.
íîê 2). Çà äîïîìîãîþ ÌÊÔ çàâäàííÿ òà ö³ë³ âòðó-
÷àíü ìîæíà âèçíà÷èòè â òåðì³íàõ ð³âíÿ ôóíêö³î-
Ʉɚɬɟɝɨɪɿʀ ɆɄɎ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɨɝɨ ɧɚɛɨɪɭ ɆɄɎ íóâàííÿ îñîáè (÷åðåç â³äïîâ³äí³ äîìåíè),
(G) = ɤɚɬɟɝɨɪɿɹ ɆɄɎ ɝɟɧɟɪɢɱɧɨɝɨ ɧɚɛɨɪɭ ɉɪɨɛɥɟɦɚ îñíîâíîãî ñòàíó çäîðîâ’ÿ òà ñóïóòí³õ çàõâîðþ-
0 1 2 3 4 âàíü, à òàêîæ â³äïîâ³äíèõ îñîáèñòèõ ôàêòîð³â òà
b130 Ɏɭɧɤɰɿʀ ɟɧɟɪɝɿʀ ɬɚ ɫɩɨɧɭɤɚɧɧɹ ɞɨ ôàêòîð³â ñåðåäîâèùà, ÿê³ ôîðìóþòü æèòòºâèé
ɞɿɣ (G) äîñâ³ä çäîðîâ’ÿ îñîáè. Ñàì³ âòðó÷àííÿ ìîæíà
b134 Ɏɭɧɤɰɿɹ ɫɧɭ âèçíà÷èòè, âèêîðèñòîâóþ÷è ̳æíàðîäíó êëàñèô³-
b152 ȿɦɨɰɿɣɧɿ ɮɭɧɤɰɿʀ (G) êàö³þ âòðó÷àíü â îõîðîí³ çäîðîâ’ÿ (ICHI), ÿêà
b280 ȼɿɞɱɭɬɬɹ ɛɨɥɸ (G)
b455 Ɏɭɧɤɰɿʀ ɬɨɥɟɪɚɧɬɧɨɫɬɿ ɞɨ
êëàñèô³êóº ôóíêö³îíóâàííÿ, õ³ðóðã³÷í³ òà ôàðìàêî-
ɮɿɡɢɱɧɨɝɨ ɧɚɜɚɧɬɚɠɟɧɧɹ ëîã³÷í³ âòðó÷àííÿ. Òàêèì ÷èíîì, ñï³ëüíå âèêîðèñ-
b620 Ɏɭɧɤɰɿʀ ɫɟɱɨɜɢɩɭɫɤɚɧɧɹ òàííÿ ÌÊÔ, ÌÊÕ òà ICHI äîçâîëÿº ïðîâåñòè
b640 ɋɟɤɫɭɚɥɶɧɿ ɮɭɧɤɰɿʀ êîìïëåêñíå ñòàíäàðòíå êîäóâàííÿ ïîâíîãî ðåàá³-
b710 Ɏɭɧɤɰɿʀ ɪɭɯɥɢɜɨɫɬɿ ɫɭɝɥɨɛɭ ë³òàö³éíîãî öèêëó, âêëþ÷àþ÷è îö³íþâàííÿ, ïðèçíà-
b730 Ɏɭɧɤɰɿʀ ɦ'ɹɡɨɜɨʀ ɫɢɥɢ ÷åííÿ, âòðó÷àííÿ òà îö³íêó18.
d230 ȼɢɤɨɧɚɧɧɹ ɳɨɞɟɧɧɨɝɨ
ɪɨɡɩɨɪɹɞɤɭ (G) Ç ìåòîþ ñïðèÿííÿ âïðîâàäæåííþ ÌÊÔ äî ïî-
d240 ɋɬɿɣɤɿɫɬɶ ɞɨ ɫɬɪɟɫɭ ɬɚ ɿɧɲɢɯ âñÿêäåííî¿ ðåàá³ë³òàö³éíî¿ ïðàêòèêè, Ñåêö³ÿ òà
ɩɫɢɯɨɥɨɝɿɱɧɢɯ ɜɢɦɨɝ Ðàäà ÔÐÌ ªÑÌÑ î÷îëþº ºâðîïåéñüê³ çóñèëëÿ â
d410 Ɂɦɿɧɚ ɨɫɧɨɜɧɢɯ ɩɨɡɢɰɿɣ ɬɿɥɚ íàïðÿìêó çàãàëüíîñèñòåìíîãî âïðîâàäæåííÿ
d415 ɉɿɞɬɪɢɦɚɧɧɹ ɩɨɥɨɠɟɧɧɹ ɬɿɥɚ ÌÊÔ ó ÔÐÌ, ðåàá³ë³òàö³¿ òà îõîðîíè çäîðîâ’ÿ â
d420 ɉɟɪɟɦɿɳɟɧɧɹ
ö³ëîìó ïðè âçàºìî䳿 ç óðÿäàìè, íåóðÿäîâèìè ó÷àñ-
d450 ɏɨɞɶɛɚ (G)
d455 ɉɟɪɟɦɿɳɟɧɧɹ ɭ ɫɩɨɫɿɛ, ɹɤɢɣ
íèêàìè òà ïðèâàòíèì ñåêòîðîì. Ö³ çóñèëëÿ óçãîä-
ɜɿɞɪɿɡɧɹɸɬɶɫɹ ɜɿɞ ɯɨɞɶɛɢ (G) æóþòüñÿ ç ðîáî÷èì ïëàíîì International Society of
d465 ɉɟɪɟɦɿɳɟɧɧɹ ɿɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ PRM (ISPRM) òà ÂÎÎÇ 19,20.
ɨɛɥɚɞɧɚɧɧɹ
d470 Ʉɨɪɢɫɬɭɜɚɧɧɹ ɬɪɚɧɫɩɨɪɬɨɦ
d510 Ɇɢɬɬɹ Îáìåæåííÿ æèòòºä³ÿëüíîñò³
d520 Ⱦɨɝɥɹɞ ɡɚ ɱɚɫɬɢɧɚɦɢ ɬɿɥɚ
d530 Ʉɨɪɢɫɬɭɜɚɧɧɹ ɬɭɚɥɟɬɨɦ Îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà ÌÊÔ ÂÎÎÇ
d540 Ʉɨɪɢɫɬɭɜɚɧɧɹ ɨɞɹɝɨɦ ɬɚ ɜɡɭɬɬɹɦ ̳æíàðîäíà êëàñèô³êàö³ÿ ôóíêö³îíóâàííÿ, îá-
d550 ȼɠɢɜɚɧɧɹ ʀɠɿ
d570 ɉɿɤɥɭɜɚɬɢɫɹ ɩɪɨ ɜɥɚɫɧɟ ɡɞɨɪɨɜ'ɹ
ìåæåííÿ æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ)4 çà-
d640 ȼɢɤɨɧɚɧɧɹ ɞɨɦɚɲɧɶɨʀ ɪɨɛɨɬɢ õîïëþº íàøå ³íòó¿òèâíå ïîíÿòòÿ ïðî îáìåæåííÿ
d660 Ⱦɨɩɨɦɨɝɚ ɿɧɲɢɦ æèòòºä³ÿëüíîñò³, ÿê ïðîáëåìè îñîáè, ùî âèêîíóº
d710 Ȼɚɡɨɜɿ ɦɿɠɨɫɨɛɢɫɬɿɫɧɿ ɜɡɚɽɦɨɞɿʀ 䳿, ÿê³ â³í ÷è âîíà ìຠàáî áàæຠâèêîíàòè, âíà-
d770 ȱɧɬɢɦɧɿ ɫɬɨɫɭɧɤɢ ñë³äîê îñíîâíîãî ñòàíó çäîðîâ’ÿ (õâîðîáè, òðàâìè
d850 Ɉɩɥɚɱɭɜɚɧɚ ɪɨɛɨɬɚ (G)
àáî íàâ³òü ñòàð³ííÿ), ùî âïëèâຠíà éîãî àáî ¿¿ âè-
d920 ȼɿɞɩɨɱɢɧɨɤ ɬɚ ɞɨɡɜɿɥɥɹ
êîíàííÿ â ðåàëüíîìó ñåðåäîâèù³ îñîáè. Ó ÌÊÔ
öåé äîñâ³ä êîíöåïòóàë³çîâàíî ç òî÷êè çîðó áàçî-
íÿ ìîæóòü îïòèì³çóâàòè çàãàëüíèé ðåçóëüòàò ôóí- âîãî ïîíÿòòÿ ôóíêö³îíóâàííÿ ÌÊÔ â ð³çíèõ äîìå-
êö³îíóâàííÿ.  ê³íöåâîìó ï³äñóìêó, ìåòà ÔÐÌ – íàõ ôóíêö³é òà ñòðóêòóð îðãàí³çìó, àêòèâíîñò³ òà
ïåðåâåñòè âíóòð³øíþ çäàòí³ñòü àáî á³îëîã³÷íå ó÷àñò³ – íàïð. âñüîãî, ùî ðîáèòü îðãàí³çì, ³ ä³é,
çäîðîâ’ÿ ó ôàêòè÷íå âèêîíàííÿ ïðè âçàºìî䳿 ç ïðîñòèõ òà ñêëàäíèõ, ùî âèêîíóþòü ëþäè – ó âçàº-
ñåðåäîâèùåì ³ îñîáèñòèìè ôàêòîðàìè, ùî ³ áóäå ìî䳿 ç ôàêòîðàìè ñåðåäîâèùà, ÿê³ ìîæóòü ä³ÿòè
çäîðîâ’ÿì æèòòÿ îñîáè. ʳëüêîìà ñëîâàìè, äëÿ ðå- ÿê áàð’ºðè (îáìåæóþòü âèêîíàííÿ) àáî ñïðèÿòëèâ³
àá³ë³òàö³¿ â ö³ëîìó ³ ÔÐÌ, çîêðåìà, ôóíêö³îíóâàí- ÷èííèêè (ï³äâèùóþòü âèêîíàííÿ). Çàâäÿêè ÌÊÔ
íÿ º â³äïðàâíîþ òî÷êîþ êë³í³÷íîãî îö³íþâàííÿ, î÷³- öåé ïîòåíö³éíî ñêëàäíèé äîñâ³ä âèçíà÷àºòüñÿ ö³ºþ
êóâàíîãî ðåçóëüòàòó âòðó÷àííÿ ³ îñíîâîþ äëÿ êëàñèô³êàö³ºþ, òîìó â³í ìîæå áóòè òî÷íî ³ ïîâí³ñòþ
óïðàâë³ííÿ ÿê³ñòþ âòðó÷àíü. îïèñàíèé íà ì³æíàðîäí³é ñòàíäàðòí³é ìîâ³.
Äëÿ îïèñó, ðîçóì³ííÿ òà âïëèâó íà ôóíêö³îíó- Âèçíà÷åííÿ îáìåæåííÿ æèòòºä³ÿëüíîñò³ çà
âàííÿ ÔÐÌ ïîâèííà ñïèðàòèñÿ íà ÌÊÔ, ÿê ç òî÷- ÌÊÔ äåùî øèðøå íàøîãî ïîâñÿêäåííîãî ïîíÿò-

42 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 1 – ÂÈÇÍÀ×ÅÍÍß ÒÀ ÏÎÍßÒÒß ÔÐÌ

Òàáëèöÿ IÁ. Ôóíêö³îíàëüí³ ïðîô³ë³. Ïðîô³ëü êàòåãîð³é ÌÊÔ; Êâàë³ô³êàòîð ÌÊÔ: îö³íþº ìàñøòàá ïðîáëåì (â³ä 0 = íåìຠïðî-
áëåìè äî 4 = ïîâíà ïðîáëåìà) òà ìàñøòàá ïîçèòèâíîãî (+) òà íåãàòèâíîãî âïëèâó ôàêòîð³â íàâêîëèøíüîãî ñåðåäîâèùà (e) òà
îñîáèñòèõ ôàêòîð³â (pf).

ɋɩɪɢɹɬɥɢɜɢɣ ɱɢɧɧɢɤ Ȼɚɪ’ɽɪ

4+ 3+ 2+ 1+ 0 1 2 3 4
e110 ɉɪɨɞɭɤɬɢ ɚɛɨ ɪɟɱɨɜɢɧɢ ɞɥɹ ɨɫɨɛɢɫɬɨɝɨ ɜɠɢɜɚɧɧɹ - -
e115 Ⱦɨɩɨɦɿɠɧɿ ɜɢɪɨɛɢ... ɞɥɹ ɨɫɨɛɢɫɬɨɝɨ ɤɨɪɢɫɬɭɜɚɧɧɹ ɭ
2 +4
ɩɨɜɫɹɤɞɟɧɧɨɦɭ ɠɢɬɬɿ
e120 Ⱦɨɩɨɦɿɠɧɿ ɜɢɪɨɛɢ… ɞɥɹ ɨɫɨɛɢɫɬɨʀ… ɦɨɛɿɥɶɧɨɫɬɿ... 1 +4
e155 ɉɪɨɟɤɬɭɜɚɧɧɹ, ɛɭɞɿɜɧɢɰɬɜɨ... ɫɩɨɪɭɞ ɞɥɹ ɩɪɢɜɚɬɧɨɝɨ
- -
ɤɨɪɢɫɬɭɜɚɧɧɹ
e310 ɇɚɣɛɥɢɠɱɿ ɪɨɞɢɱɿ - -
e320 Ⱦɪɭɡɿ - -
e355 Ɏɚɯɿɜɰɿ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ - -
e460 ɋɭɫɩɿɥɶɧɿ ɫɬɚɜɥɟɧɧɹ - -
e580 ɉɨɫɥɭɝɢ, ɫɢɫɬɟɦɢ ɬɚ ɩɨɥɿɬɢɤɚ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ’ɹ - -
pf ȼɩɟɜɧɟɧɿɫɬɶ ɜ ɫɨɛɿ ɉȾ 0
pf Ɇɨɬɢɜɚɰɿɹ - -
pf Ⱥɫɟɪɬɢɜɧɿɫɬɶ ɉȾ 0
pf Ɇɨɬɢɜɢ - -


òÿ, îñê³ëüêè âîíî îõîïëþº ïîðóøåííÿ (ïðîáëåìè
ôóíêö³é ³ ñòðóêòóð îðãàí³çìó) ³ ÷³òêî ðîçð³çíÿº ïðî-
áëåìè, ÿê³ ïîâí³ñòþ º ðåçóëüòàòîì îñíîâíîãî ñòà-
íó çäîðîâ’ÿ (çäàòí³ñòü) â³ä ïðîáëåì, ùî âèíèêàþòü
â ðåçóëüòàò³ âçàºìî䳿 ì³æ çäàòí³ñòþ òà ôàêòîðà-
ìè ñåðåäîâèùà ³ îñîáèñòèìè ôàêòîðàìè (âèêîíàí-
íÿ). Îñê³ëüêè ðåàá³ë³òàö³ÿ â ö³ëîìó ³ ÔÐÌ, çîêðå-
ìà, ñïðÿìîâàí³ íà îïòèì³çàö³þ ôóíêö³îíóâàííÿ â
óñ³õ äîìåíàõ, ìîæíà ñêàçàòè, ùî ö³ ñòðàòå㳿 îõî-
ðîíè çäîðîâ’ÿ ñïðÿìîâàí³ òà íàìàãàþòüñÿ óñóíó-
òè àáî ïîë³ïøèòè äîñâ³ä îáìåæåíü æèòòºä³ÿëü-
íîñò³.
Åï³äåì³îëîã³ÿ îáìåæåíü æèòòºä³ÿëüíîñò³
Ïðîòÿãîì äåñÿòèë³òü ³ñíóâàâ âèêëèê ñòîñîâíî
äîñÿãíåííÿ êîíñåíñóñó ùîäî âèçíà÷åííÿ îáìå-
æåííÿ æèòòºä³ÿëüíîñò³, ÿê ïåðøîãî êðîêó äî ïðàâ-
äèâî¿ åï³äåì³îëî㳿 îáìåæåíü æèòòºä³ÿëüíîñò³.
Ïîïðè òå, ùî ÌÊÔ çàðàç ñòâîðèëî êîíñåíñóñíó
êîíöåïòóàë³çàö³þ, ñó÷àñíèé ñòàí åï³äåì³îëî㳿 îá-
ìåæåíü æèòòºä³ÿëüíîñò³ ìຠòåíäåíö³þ äî ïëóòà-
íèíè äâîõ äîñâ³ä³â: ïðîáëåìè, ÿê³ ëþäè çàçíàþòü
ïðè âèêîíàíí³ ä³é ïîâí³ñòþ âíàñë³äîê ¿õ ñòàíó çäî-
ðîâ’ÿ – ïåðñïåêòèâà çäàòíîñò³, òà ïðîáëåìè, ÿê³
îñîáà çàçíຠâíàñë³äîê âçàºìî䳿 ì³æ ¿¿ ñòàíîì çäî-
ðîâ’ÿ òà ôàêòîðàìè ñåðåäîâèùà òà îñîáèñòèìè
ôàêòîðàìè – ïåðñïåêòèâà âèêîíàííÿ. Õî÷à âîíè
ðîçð³çíÿþòüñÿ, îáèäâ³ ïåðñïåêòèâè âàæëèâ³ äëÿ
îö³íêè ïîøèðåíîñò³ îáìåæåíü æèòòºä³ÿëüíîñò³, à
òàêîæ äëÿ ðîçóì³ííÿ ïðàêòèêè ðåàá³ë³òàö³¿7. ³äïî-
â³äíî äî Ãëîáàëüíîãî Ïëàíó ä³é ç îáìåæåíü æèò-
òºä³ÿëüíîñò³21, ÂÎÎÇ çðîáëåíî êðîê äî óäîñêîíà-
ëåííÿ åï³äåì³îëî㳿 îáìåæåííÿ æèòòºä³ÿëüíîñò³
øëÿõîì ðîçðîáêè Ìîäåëüíîãî îãëÿäó îáìåæåíü
æèòòºä³ÿëüíîñò³, ùî ÷³òêî â³äð³çíÿº ïåðñïåêòèâè
çäàòíîñò³ â³ä ïåðñïåêòèâ âèêîíàííÿ, ç ìåòîþ â³äîê-
ðåìëåííÿ çäîðîâ’ÿ â³ä ñåðåäîâèùíèõ äåòåðì³íàíò
äîñâ³äó îáìåæåíü æèòòºä³ÿëüíîñò³22.
Âòðó÷àííÿ ïðè îáìåæåííÿõ
æèòòºä³ÿëüíîñò³
Ç òî÷êè çîðó ïåðñïåêòèâè âèêîíàííÿ, òîáòî
ôàêòè÷íîãî æèòòºâîãî äîñâ³äó îáìåæåííÿ æèòòº-
ä³ÿëüíîñò³ – îáìåæåííÿ çäàòíîñò³ âèêîíàííÿ â
ïåâíèõ äîìåíàõ, ÿê íàïðèêëàä, ìîá³ëüí³ñòü àáî
ãîëîâí³ ñôåðè æèòòÿ, ìîæóòü áóòè ñóòòºâî çìåí-
øåí³ â³äïîâ³äíèìè äîïîì³æíèìè ïðèñòðîÿìè òà
³íøèìè ñïðèÿòëèâèìè ÷èííèêàìè ñåðåäîâèùà, ÿê³
ï³äâèùóþòü âèêîíàííÿ ³, òàêèì ÷èíîì, çìåíøóþòü
îáìåæåííÿ æèòòºä³ÿëüíîñò³. Îäíàê, ö³ ðåàá³ë³-
òàö³éí³ âòðó÷àííÿ âèìàãàþòü â³ä íàñ ìîæëèâîñò³
ïåðåâåñòè ïîòåíö³éí³ âèãîäè â³ä ïîë³ïøåííÿ çäàò-
íîñò³ ³ çì³í ñåðåäîâèùà äî ôàêòè÷íîãî âèêîíàííÿ
ä³é. Ùî ñòîñóºòüñÿ ïðàêòèêè ðåàá³ë³òàö³¿, ÌÊÔ
óòî÷íþº, ùî ö³ âòðó÷àííÿ ïîâèíí³ çîñåðåäæóâàòè-
ñÿ íà âçàºìî䳿 îñîáè òà ñåðåäîâèùà. Åôåê-
òèâí³ñòü òà ÿê³ñòü ðåàá³ë³òàö³éíèõ çàõîä³â ïîâèíí³
îö³íþâàòèñÿ íå ïðîñòî â ì³ðó ï³äâèùåííÿ çäàòíîñò³
÷è ñïðèÿííÿ ñåðåäîâèùà, à â ôàêòè÷íîìó ðåçóëü-
òàò³ ö³º¿ âçàºìî䳿. Ñàìå öå é îçíà÷ຠîïòèì³çóâà-
òè ôóíêö³îíóâàííÿ.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 43
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Îö³íêà îáìåæåíü æèòòºä³ÿëüíîñò³
Îñê³ëüêè äîìåíè ôóíêö³îíóâàííÿ ïðîñòÿãàþòü-
ñÿ â êîíòèíóóì³ â³ä “íåìຠïðîáëåìè” äî “ïîâíà
ïðîáëåìà”, îáìåæåííÿ æèòòºä³ÿëüíîñò³ íå º ïðî-
òèëåæí³ñòþ ôóíêö³îíóâàííþ, à ñêîð³øå º ä³àïàçî-
íîì ôóíêö³îíóâàííÿ â çàãàëüíîìó êîíòèíóóì³, ÿêèé
³íòó¿òèâíî ïðîñòÿãàºòüñÿ â á³ê ê³íöÿ “ïîâíà ïðîáëå-
ìà” öüîãî êîíòèíóóìó. Òîìó â êîíòèíóóì³ íåìàº
ºäèíî¿ òî÷êè, äå äëÿ êîæíîãî äîìåíó çàê³í÷óºòü-
ñÿ ôóíêö³îíóâàííÿ ³ ïî÷èíàºòüñÿ îáìåæåííÿ æèò-
òºä³ÿëüíîñò³. Ö³ ïîðîãîâ³ çíà÷åííÿ áóäóòü âèçíà-
÷àòèñÿ ïî-ð³çíîìó äëÿ ð³çíèõ ö³ëåé. Öå âàæëèâî ç
åï³äåì³îëîã³÷íî¿ òî÷êè çîðó, îñê³ëüêè, íàïð. þðè-
äè÷í³ âèçíà÷åííÿ îáìåæåíü æèòòºä³ÿëüíîñò³ âñòà-
íîâëÿòü ïîðîãîâ³ ïðàâîâ³ ïîêàçíèêè ç ìåòîþ íà-
äàííÿ ï³äòðèìêè òà ïîñëóã, ÿê³ º ð³çíèìè ì³æ
êðà¿íàìè òà, íàâ³òü, ì³æ ð³çíèìè ì³í³ñòåðñòâàìè
âñåðåäèí³ êðà¿í. Ö³ âèçíà÷åííÿ íå ìîæóòü çàáåç-
ïå÷èòè îñíîâó äëÿ ì³æíàðîäíî¿ ïîð³âíÿëüíî¿
åï³äåì³îëî㳿 îáìåæåíü æèòòºä³ÿëüíîñò³, ÿêà íà-
âïàêè âèìàãຠñòàíäàðòèçîâàíî¿ ìåòðèêè ôóíêö³-
îíóâàííÿ, îòðèìàíî¿ ïñèõîìåòðè÷íèì øëÿõîì. Ùî
ñòîñóºòüñÿ êë³í³÷íî¿ ïðàêòèêè, õî÷à òóò ìîæå áóòè
çàãàëüíà çãîäà ùîäî ñóáîïòèìàëüíîãî ôóíêö³îíó-
âàííÿ â áóäü-ÿêîìó äîìåí³, õîðîøà êë³í³÷íà ïðàê-
òèêà âèçíàº, ùî ð³âåíü ôóíêö³îíóâàííÿ, ïðè ÿêîìó
ëþäèíà çàçíຠïîðóøåíü æèòòºä³ÿëüíîñò³, áóäå
âèçíà÷àòèñÿ ïåðñîíàëüíèìè òà êóëüòóðàëüíèìè
î÷³êóâàííÿìè. Ïåðñîíà-îð³ºíòîâàíà äîïîìîãà âè-
ìàãàº, ùîá ö³ î÷³êóâàííÿ áóëè äîòðèìàí³, íàâ³òü
ÿêùî â ê³íöåâîìó ï³äñóìêó âîíè íå âèçíà÷àþòü õî-
ðîøó êë³í³÷íó ïðàêòèêó.
Îáìåæåííÿ æèòòºä³ÿëüíîñò³ – äâ³ ñóñï³ëüí³
ïåðñïåêòèâè
Êîíöåïòóàë³çàö³ÿ ôóíêö³îíóâàííÿ òà îáìåæåíü
æèòòºä³ÿëüíîñò³ ÌÊÔ ïîÿñíþº ïîñò³éíó ðîçá³æ-
í³ñòü ó äîñâ³ä³ îáìåæåííÿ æèòòºä³ÿëüíîñò³, ùî
â³äîáðàæàºòüñÿ ó äâîõ ñîö³àëüíèõ ïåðñïåêòè-
âàõ7,23. Ç îäíîãî áîêó îáìåæåííÿ æèòòºä³ÿëüíîñò³,
áåçóìîâíî, º óí³âåðñàëüíîþ îçíàêîþ ëþäñüêîãî
ñòàíó â òîìó ñåíñ³, ùî êîæíà ëþäèíà áóäå çàçíà-
âàòè àáî ðèçèêóº çàçíàòè îáìåæåíü çäàòíîñò³ òà
ïðîáëåì ç âèêîíàííÿì â îäíîìó ÷è äåê³ëüêîõ äî-
ìåíàõ ôóíêö³îíóâàííÿ. ² õî÷à íå êîæíà ëþäèíà
áóäå çàçíàâàòè âàæêîãî îáìåæåííÿ æèòòºä³ÿëü-
íîñò³ ïðîòÿãîì ñâîãî æèòòÿ, ñàìå ïî ñîá³ ñòàð³í-
íÿ º ïðîöåñîì íàêîïè÷åííÿ ïîðóøåíü ó áàãàòüîõ
äîìåíàõ, êîæíå ç ÿêèõ íèçüêîãî àáî ñåðåäíüîãî
ñòóïåíÿ òÿæêîñò³, àëå â ñóêóïíîñò³ äîñèòü îáìå-
æóº. Öå îáìåæåííÿ æèòòºä³ÿëüíîñò³ º óí³âåðñàëü-
íîþ îçíàêîþ, òîìó öå ïðîñòî îïèñîâèé ôàêò åï³-
äåì³îëî㳿 ôóíêö³îíóâàííÿ. Ó òîé æå ÷àñ, îäíàê, â
îñíîâíîìó ç ñîö³àëüíî-ïîë³òè÷íèõ ïðè÷èí, ìè ñîö³-
àëüíî ³äåíòèô³êóºìî ãðóïó îñ³á, ÿê «ëþäåé ç îá-
44 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ìåæåííÿìè æèòòºä³ÿëüíîñò³», ÿê, ôàêòè÷íî, ãðóïó
ìåíøîñò³, ÿêà, ÿê ãðóïà, ìàðã³íàë³çóºòüñÿ ç çàãàëü-
íîãî ïîòîêó ³ ÿê³é çàïåðå÷óºòüñÿ, â ò³é ÷è ³íø³é ì³ð³,
ïîâíå çàëó÷åííÿ ³ åôåêòèâíà ó÷àñòü ó æèòò³ ñóñ-
ï³ëüñòâà. Öÿ ñîö³àëüíà ïðîáëåìà íå º óí³âåðñàëü-
íîþ, àëå îáìåæåíà îêðåìîþ ìåíø³ñòþ.
Ðåàá³ë³òàö³ÿ çîñåðåäæåíà íà çàãàëüíîìó ñåíñ³
îáìåæåííÿ æèòòºä³ÿëüíîñò³. Âíàñë³äîê ñòàð³ííÿ
íàñåëåííÿ – ÷àñòêîâî âèêëèêàíîãî óñï³õîì ñó÷àñ-
íî¿ ìåäèöèíè òà çá³ëüøåííÿì âèæèâàííÿ ï³ñëÿ õâî-
ðîá òà òðàâì – âñå á³ëüøå ðåàá³ë³òàö³éíèõ çàõîä³â
ñïðÿìîâàí³ íå ò³ëüêè íà ñåðéîçí³ ïðîáëåìè ç ôóí-
êö³îíóâàííÿì, òàê³, ÿê ³íñóëüò òà òðàâìè ñïèííîãî
ìîçêó (ÑÌÒ), àëå òàêîæ íà ñèòóàö³¿ ç äåê³ëüêîìà,
àëå â³äíîñíî ëåãêèìè ÷è ñåðåäí³ìè îáìåæåííÿìè
æèòòºä³ÿëüíîñò³, ïîâ’ÿçàíèìè ³ç ïðîöåñîì ñòàð³í-
íÿ ³ ïîâ’ÿçàíèìè ç ê³ëüêîìà ñòàíàìè çäîðîâ’ÿ, à íå
ç îäíèì âàæêèì îáìåæåííÿì æèòòºä³ÿëüíîñò³, ÿêà
áåçïîñåðåäíüî ïîâ’ÿçàíà ç îäíèì âàæêèì õðîí³÷-
íèì ñòàíîì çäîðîâ’ÿ24,25. Òîìó ìàéáóòí³ìè âèê-
ëèêàìè ðåàá³ë³òàö³¿, ÿê ñòðàòå㳿 îõîðîíè çäîðîâ’ÿ
òà, çîêðåìà, ÔÐÌ, â êîíòåêñò³ çá³ëüøåííÿ òÿãàðÿ
äîïîìîãè, çá³ëüøåííÿ âèòðàò íà îõîðîíó çäîðîâ’ÿ
òà ñîö³àëüíó äîïîìîãó òà á³ëüøèõ ñîö³àëüíèõ î÷³-
êóâàíü ãàðíîãî çäîðîâ’ÿ, áóäóòü, òàêèì ÷èíîì,
ñòâîðåííÿ êîìïëåêñíèõ ñòðàòåã³é âòðó÷àííÿ, ÿê³
ìîæóòü äàòè â³äïîâ³ä³ ïðè ïîâíîìó îáñÿç³ îáìå-
æåíü æèòòºä³ÿëüíîñò³, ùî âêëþ÷àòèìóòü äåê³ëü-
êà ð³çíîìàí³òíèõ äîìåí³â ôóíêö³îíóâàííÿ. Íå ìåíø
âàæëèâèì áóäå îö³íêà ðåçóëüòàò³â öèõ âòðó÷àíü,
ùîá çàáåçïå÷èòè ÿê³ñòü ³ íàëåæí³ âèòðàòè. Àëå ÿê
ñóñï³ëüñòâî – ó òîìó ÷èñë³ ôàõ³âö³ ðåàá³ë³òàö³¿ òà
ïðîôåñ³éí³ îðãàí³çàö³¿ – ìè ïîâèíí³ âèð³øèòè ïðî-
áëåìè òèõ ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³,
ÿê³ âèêëþ÷åí³ ç ïîâíî¿ ó÷àñò³ â æèòò³ ñóñï³ëüñòâà.
Òóò îñíîâíà óâàãà ïîâèííà áóòè çîñåðåäæåíà íà
ñîö³àëüí³é ö³ë³ ïîâíî¿ ³íêëþ糿 â³äïîâ³äíî äî îñíîâ-
íèõ ïðàâ ëþäèíè. Ö³ ïðàâà áóëè ÷³òêî ï³äòâåðäæåí³
äëÿ ö³º¿ ñîö³àëüíî¿ ãðóïè â ðàìêàõ Êîíâåíö³¿ ïðî
ïðàâà îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ Îðãàí³-
çàö³¿ Îá’ºäíàíèõ Íàö³é, ïðèéíÿòî¿ ó 2006 ðîö³26.
Ðåàá³ë³òàö³ÿ
Ðåàá³ë³òàö³ÿ, îñíîâíà ñòðàòåã³ÿ îõîðîíè
çäîðîâ’ÿ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ
Ç òî÷êè çîðó ñèñòåìè îõîðîíè çäîðîâ’ÿ ðåàá³-
ë³òàö³ÿ º îäí³ºþ ç ï’ÿòè ñòðàòåã³é îõîðîíè çäîðî-
â’ÿ13,14, ö³ë³ òà ïîêàçíèêè ðåçóëüòàòèâíîñò³ ÿêèõ
ïîêàçàí³ â Òàáëèö³ II27. Ç ìîìåíòó ïðèéíÿòòÿ Äåê-
ëàðàö³¿ â Àëìà-Àò³ ó 1978, ðåàá³ë³òàö³ÿ ââàæàºòü-
ñÿ îñíîâíîþ ñòðàòå㳺þ îõîðîíè çäîðîâ’ÿ ó ïåð-
âèíí³é ìåäè÷í³é äîïîìîç³, ÿêà ñïðÿìîâàíà íà
âèð³øåííÿ “îñíîâíèõ ïðîáëåì â ñôåð³ çäîðîâ’ÿ â
¹2(2) *2018

Òàáëèöÿ II. Îñíîâí³ ñòðàòå㳿 çäîðîâ’ÿ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ, ¿õí³ ö³ë³ òà ïîêàçíèêè, àäàïòîâàí³ â³ä: Stucki G, Bickenbach
J. Functioning: the third health indicator in the health system and the key indicator for rehabilitation. Eur J Phys Rehabil Med. 2017;53(1):134-
8.
ɋɬɪɚɬɟɝɿɹ ɐɿɥɶ ɡɞɨɪɨɜ’ɹ
ɉɪɟɜɟɧɬɢɜɧɚ ɉɪɨɮɿɥɚɤɬɢɤɚ ɫɬɚɧɭ ɡɞɨɪɨɜ'ɹ (ɩɪɨɮɿɥɚɤɬɢɤɚ
ɯɜɨɪɨɛɢ)
ɉɪɨɦɨɬɢɜɧɚ Ɉɩɬɢɦɚɥɶɧɟ ɛɿɨɥɨɝɿɱɧɟ ɡɞɨɪɨɜ'ɹ
Ʌɿɤɭɜɚɥɶɧɚ Ʉɨɧɬɪɨɥɶ ɫɬɚɧɭ ɡɞɨɪɨɜ'ɹ
(ɤɨɧɬɪɨɥɶ ɯɜɨɪɨɛɢ)
Ɋɟɚɛɿɥɿɬɚɰɿɣɧɚ Ɉɩɬɢɦɚɥɶɧɟ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ
ɉɿɞɬɪɢɦɭɸɱɚ Ɉɩɬɢɦɚɥɶɧɟ ɡɞɨɪɨɜ’ɹ ɠɢɬɬɹ
ɉɚɥɿɚɬɢɜɧɚ əɤɿɫɬɶ ɠɢɬɬɹ ɬɚ ɛɥɚɝɨɩɨɥɭɱɱɹ
ñóñï³ëüñòâ³” øëÿõîì “íàäàííÿ ïðîìîö³éíèõ, ïðå-
âåíòèâíèõ, ë³êóâàëüíèõ òà ðåàá³ë³òàö³éíèõ ïî-
ñëóã” 28.
Âèíèêíåííÿ ðåàá³ë³òàö³¿, ÿê êëþ÷îâî¿
ñòðàòå㳿 îõîðîíè çäîðîâ’ÿ â ÕÕ² ñòîë³òò³
˳êóâàëüí³, ïðîô³ëàêòè÷í³ òà ïðîìîö³éí³ ñòðà-
òå㳿 îõîðîíè çäîðîâ’ÿ â³äïîâ³äàëè çà çðîñòàííÿ
âïëèâó ìåäèöèíè ³ ãðîìàäñüêîãî çäîðîâ’ÿ ïðîòÿ-
ãîì á³ëüøî¿ ÷àñòèíè XIX ³ XX ñòîë³òü. Àëå â áëèæ-
÷å äî ê³íöÿ ìèíóëîãî ñòîë³òòÿ âèíèêëè åï³äåì³î-
ëîã³÷í³ ïðîáëåìè, ãîëîâíèì ÷èíîì ÷åðåç óñï³õè
ïîïåðåäí³õ äåñÿòèë³òü. Çîêðåìà, íàñåëåííÿ ñòàð³º
÷åðåç ïîë³ïøåííÿ ìåäè÷íîãî îáñëóãîâóâàííÿ ³
Òàáëèöÿ III. Êîíöåïòóàëüíèé îïèñ ðåàá³ë³òàö³éíî¿ ñòðàòå㳿,
ùî áàçóºòüñÿ íà ̳æíàðîäí³é êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ,
îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ), ìîäèô³êî-
âàíà âåðñ³ÿ (òåðì³íè ÌÊÔ ïîçíà÷åí³ æèðíèì øðèôòîì).
Ɋɟɚɛɿɥɿɬɚɰɿɹ ɽ ɫɬɪɚɬɟɝɿɽɸ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ, ɹɤɚ
ɫɩɢɪɚɽɬɶɫɹ ɧɚ ɿɧɬɟɝɪɚɬɢɜɧɭ ɦɨɞɟɥɶ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ,
ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɬɚ ɡɞɨɪɨɜ'ɹ ȼɈɈɁ,
ɡɚɫɬɨɫɨɜɭɽɬɶɫɹ ɬɚ ɿɧɬɟɝɪɭɽ:
ĺ ɩɿɞɯɨɞɢ ɞɨ ɨɰɿɧɸɜɚɧɧɹ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɜ ɫɜɿɬɥɿ
ɫɬɚɧɿɜ ɡɞɨɪɨɜ’ɹ
ĺ ɩɿɞɯɨɞɢ ɞɨ ɨɩɬɢɦɿɡɚɰɿʀ ɡɞɚɬɧɨɫɬɿ ɨɫɨɛɢ
ĺ ɩɿɞɯɨɞɢ, ɹɤɿ ɪɨɡɛɭɞɨɜɭɸɬɶ ɿ ɡɦɿɰɧɸɸɬɶ ɪɟɫɭɪɫɢ ɨɫɨɛɢ
ĺ ɩɿɞɯɨɞɢ, ɹɤɿ ɡɚɛɟɡɩɟɱɭɸɬɶ ɫɟɪɟɞɨɜɢɳɟ, ɳɨ ɫɩɪɢɹɽ
ĺ ɩɿɞɯɨɞɢ, ɹɤɿ ɪɨɡɜɢɜɚɸɬɶ ɜɢɤɨɧɚɧɧɹ ɨɫɨɛɢ
ĺ ɩɿɞɯɨɞɢ, ɹɤɿ ɩɿɞɜɢɳɭɸɬɶ ɹɤɿɫɬɶ ɠɢɬɬɹ ɨɫɨɛɢ,
ɩɨɜ'ɹɡɚɧɭ ɡɿ ɡɞɨɪɨɜ'ɹɦ, ɭ ɩɚɪɬɧɟɪɫɬɜɿ ɦɿɠ ɨɫɨɛɨɸ ɬɚ
ɧɚɞɚɜɚɱɟɦ, ɜ ɪɨɡɭɦɿɧɧɿ ɫɩɪɢɣɧɹɬɬɹ ɨɫɨɛɨɸ ɣɨɝɨ ɚɛɨ ʀʀ
ɦɿɫɰɹ ɜ ɠɢɬɬɿ;
ɩɪɨɬɹɝɨɦ ɩɟɪɟɛɿɝɭ ɫɬɚɧɭ ɡɞɨɪɨɜ'ɹ ɬɚ ɜ ɭɫɿɯ ɜɿɤɨɜɢɯ
ɝɪɭɩɚɯ;
ɜɩɪɨɞɨɜɠ ɬɚ ɱɟɪɟɡ ɤɨɧɬɢɧɭɭɦ ɞɨɩɨɦɨɝɢ, ɜɤɥɸɱɚɸɱɢ
ɥɿɤɚɪɧɿ,
ɪɟɚɛɿɥɿɬɚɰɿɣɧɿ ɡɚɤɥɚɞɢ ɬɚ ɝɪɨɦɚɞɢ,
ɿ ɦɿɠ ɫɟɤɬɨɪɚɦɢ, ɜɤɥɸɱɚɸɱɢ ɨɯɨɪɨɧɭ ɡɞɨɪɨɜ'ɹ, ɨɫɜɿɬɭ,
ɩɪɚɰɸ ɬɚ ɫɨɰɿɚɥɶɧɿ ɜɿɞɧɨɫɢɧɢ;
ɡ ɰɿɥɥɸ
ɧɚɞɚɬɢ ɦɨɠɥɢɜɿɫɬɶ ɨɫɨɛɚɦ ɡɿ ɫɬɚɧɚɦɢ ɡɞɨɪɨɜ'ɹ, ɳɨ
ɡɚɡɧɚɸɬɶ, ɚɛɨ ɦɨɠɭɬɶ ɡɚɡɧɚɬɢ ɨɛɦɟɠɟɧɶ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ, ɞɨɫɹɝɧɭɬɢ ɬɚ ɩɿɞɬɪɢɦɚɬɢ ɨɩɬɢɦɚɥɶɧɟ
ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ
ɡ: Meyer T, Gutenbrunner C, Bickenbach J, Cieza A, Melvin
J, Stucki G. Towards a conceptual description of
rehabilitation as a health strategy. Journal of Rehabilitation
Medicine. 2011;43(9):765-9. Table II p. 768.
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 1 – ÂÈÇÍÀ×ÅÍÍß ÒÀ ÏÎÍßÒÒß ÔÐÌ
ȱɧɞɢɤɚɬɨɪ
Ɂɚɯɜɨɪɸɜɚɧɿɫɬɶ ɆɄɏ
ɆɄɎ – ɡɞɚɬɧɿɫɬɶ ɆɄɎ
ɋɦɟɪɬɧɿɫɬɶ ɆɄɏ
ɆɄɎ – ɡɞɚɬɧɿɫɬɶ ɬɚ ɜɢɤɨɧɚɧɧɹ ɆɄɎ
ɆɄɎ – ɜɢɤɨɧɚɧɧɹ ɆɄɎ
Ɂɚɞɨɜɨɥɟɧɧɹ
ï³äâèùåííÿ âèæèâàííÿ ïðè ñòàíàõ, ùî ðàí³øå ââà-
æàëèñÿ ñìåðòåëüíèìè, à õðîí³÷í³ íå³íôåêö³éí³ çà-
õâîðþâàííÿ ñòàëè, ïðèíàéìí³, â âèñîêîðîçâèíåíèõ
êðà¿íàõ, îñíîâíèì äæåðåëîì ñìåðòíîñò³28. ßê íà-
ñë³äîê, â öüîìó ñòîë³òò³, êð³ì ï³äòðèìêè ö³ë³ ç
Ȼɥɨɤ 4.1. ɓɨ ɬɚɤɟ ɪɟɚɛɿɥɿɬɚɰɿɹ?
ɐɹ Ⱦɨɩɨɜɿɞɶ ɜɢɡɧɚɱɚɽ ɪɟɚɛɿɥɿɬɚɰɿɸ ɹɤ «ɤɨɦɩɥɟɤɫ ɡɚɯɨɞɿɜ, ɹɤɿ
ɞɨɩɨɦɚɝɚɸɬɶ ɥɸɞɹɦ, ɹɤɿ ɡɚɡɧɚɸɬɶ ɚɛɨ ɦɨɠɭɬɶ ɡɚɡɧɚɬɢ
ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ, ɞɨɫɹɝɬɢ ɿ ɩɿɞɬɪɢɦɭɜɚɬɢ
ɨɩɬɢɦɚɥɶɧɟ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɭ ɜɡɚɽɦɨɞɿʀ ɡɿ ɫɜɨʀɦɚ
ɫɟɪɟɞɨɜɢɳɚɦɢ». ȱɧɨɞɿ ɩɪɨɜɨɞɢɬɶɫɹ ɪɿɡɧɢɰɹ ɦɿɠ ɚɛɿɥɿɬɚɰɿɽɸ,
ɹɤɚ ɫɩɪɹɦɨɜɚɧɚ ɧɚ ɞɨɩɨɦɨɝɭ ɬɢɦ, ɯɬɨ ɧɚɛɭɜ ɨɛɦɟɠɟɧɧɹ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɡ ɧɚɪɨɞɠɟɧɧɹ, ɚɛɨ ɪɚɧɨ ɜ ɠɢɬɬɿ, ɪɨɡɜɢɧɭɬɢ
ɦɚɤɫɢɦɚɥɶɧɟ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ; ɿ ɪɟɚɛɿɥɿɬɚɰɿʀ, ɞɟ ɬɿɦ, ɯɬɨ
ɡɚɡɧɚɜ ɜɬɪɚɬɢ ɮɭɧɤɰɿʀ, ɞɨɩɨɦɚɝɚɸɬɶ ɩɨɜɟɪɧɭɬɢ ɦɚɤɫɢɦɚɥɶɧɟ
ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ (2).
ɍ ɰɿɽʀ ɝɥɚɜɿ ɬɟɪɦɿɧ "ɪɟɚɛɿɥɿɬɚɰɿɹ" ɨɯɨɩɥɸɽ ɨɛɢɞɜɚ ɜɢɞɢ
ɜɬɪɭɱɚɧɧɹ. ɏɨɱɚ ɤɨɧɰɟɩɰɿɹ ɪɟɚɛɿɥɿɬɚɰɿʀ ɞɨɫɢɬɶ ɲɢɪɨɤɚ, ɜ
ɰɟɣ ɬɟɪɦɿɧ ɧɟ ɦɨɠɟ ɛɭɬɢ ɜɤɥɸɱɟɧɨ ɜɫɟ, ɳɨ ɫɬɨɫɭɽɬɶɫɹ
ɨɛɦɟɠɟɧɧɹ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ. Ɋɟɚɛɿɥɿɬɚɰɿɹ ɫɩɪɹɦɨɜɚɧɚ ɧɚ
ɩɨɥɿɩɲɟɧɧɹ ɿɧɞɢɜɿɞɭɚɥɶɧɨɝɨ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ, ɫɤɚɠɿɦɨ,
ɲɥɹɯɨɦ ɩɨɥɿɩɲɟɧɧɹ ɡɞɚɬɧɨɫɬɿ ɨɫɨɛɢ ʀɫɬɢ ɿ ɩɢɬɢ
ɫɚɦɨɫɬɿɣɧɨ. Ɋɟɚɛɿɥɿɬɚɰɿɹ ɬɚɤɨɠ ɜɤɥɸɱɚɽ ɜɧɟɫɟɧɧɹ ɡɦɿɧ ɭ
ɫɟɪɟɞɨɜɢɳɟ ɨɫɨɛɢ – ɧɚɩɪɢɤɥɚɞ, ɲɥɹɯɨɦ ɜɫɬɚɧɨɜɥɟɧɧɹ
ɩɨɪɭɱɧɹ ɭ ɬɭɚɥɟɬɿ. Ⱥɥɟ ɿɧɿɰɿɚɬɢɜɢ ɳɨɞɨ ɭɫɭɧɟɧɧɹ ɛɚɪ’ɽɪɿɜ
ɧɚ ɫɭɫɩɿɥɶɧɨɦɭ ɪɿɜɧɿ, ɬɚɤɿ ɹɤ, ɧɚɩɪɢɤɥɚɞ, ɜɫɬɚɧɨɜɥɟɧɧɹ
ɩɚɧɞɭɫɭ ɜ ɝɪɨɦɚɞɫɶɤɭ ɛɭɞɿɜɥɸ, ɧɟ ɪɨɡɝɥɹɞɚɸɬɶɫɹ ɹɤ
ɪɟɚɛɿɥɿɬɚɰɿɹ ɜ ɰɿɣ Ⱦɨɩɨɜɿɞɿ.
Ɋɟɚɛɿɥɿɬɚɰɿɹ ɡɦɟɧɲɭɽ ɜɩɥɢɜ ɲɢɪɨɤɨɝɨ ɫɩɟɤɬɪɭ ɫɬɚɧɿɜ
ɡɞɨɪɨɜ'ɹ. Ɂɚɡɜɢɱɚɣ, ɪɟɚɛɿɥɿɬɚɰɿɹ ɜɿɞɛɭɜɚɽɬɶɫɹ ɩɪɨɬɹɝɨɦ
ɩɟɜɧɨɝɨ ɩɟɪɿɨɞɭ ɱɚɫɭ, ɚɥɟ ɦɨɠɟ ɜɤɥɸɱɚɬɢ ɨɞɧɨɪɚɡɨɜɿ ɚɛɨ
ɱɢɫɥɟɧɧɿ ɜɬɪɭɱɚɧɧɹ, ɳɨ ɧɚɞɚɸɬɶɫɹ ɨɞɧɢɦ ɚɛɨ ɤɨɦɚɧɞɨɸ
ɮɚɯɿɜɰɿɜ ɪɟɚɛɿɥɿɬɚɰɿʀ, ɬɚ ɦɨɠɭɬɶ ɛɭɬɢ ɩɨɬɪɿɛɧɿ ɩɨɱɢɧɚɸɱɢ
ɡ ɝɨɫɬɪɨʀ ɚɛɨ ɩɨɱɚɬɤɨɜɨʀ ɮɚɡɿ ɨɞɪɚɡɭ ɩɿɫɥɹ ɜɢɡɧɚɱɟɧɧɹ
ɫɬɚɧɭ ɡɞɨɪɨɜ'ɹ ɞɨ ɩɿɞɝɨɫɬɪɨʀ ɿ ɩɿɞɬɪɢɦɭɸɱɿɣ ɮɚɡ.
Ɋɟɚɛɿɥɿɬɚɰɿɹ ɜɤɥɸɱɚɽ ɜɢɹɜɥɟɧɧɹ ɩɪɨɛɥɟɦ ɬɚ ɩɨɬɪɟɛ ɨɫɨɛɢ,
ɩɨɜ'ɹɡɚɧɧɹ ɩɪɨɛɥɟɦ ɿɡ ɜɿɞɩɨɜɿɞɧɢɦɢ ɮɚɤɬɨɪɚɦɢ ɩɟɪɫɨɧɢ
ɬɚ ʀʀ ɫɟɪɟɞɨɜɢɳɚ, ɜɢɡɧɚɱɟɧɧɹ ɪɟɚɛɿɥɿɬɚɰɿɣɧɢɯ ɰɿɥɟɣ,
ɩɥɚɧɭɜɚɧɧɹ ɬɚ ɜɩɪɨɜɚɞɠɟɧɧɹ ɡɚɯɨɞɿɜ ɬɚ ɨɰɿɧɸɜɚɧɧɹ
ɪɟɡɭɥɶɬɚɬɿɜ (ɞɢɜ. ɦɚɥɸɧɨɤ ɧɢɠɱɟ). Ɉɫɜɿɬɚ ɥɸɞɟɣ ɡ
ɨɛɦɟɠɟɧɧɹɦɢ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɽ ɞɭɠɟ ɜɚɠɥɢɜɨɸ ɞɥɹ
ɪɨɡɜɢɬɤɭ ɡɧɚɧɶ ɿ ɧɚɜɢɱɨɤ ɞɥɹ ɫɚɦɨɞɨɩɨɦɨɝɢ, ɞɨɝɥɹɞɭ,
ɭɩɪɚɜɥɿɧɧɹ ɿ ɩɪɢɣɧɹɬɬɹ ɪɿɲɟɧɶ. Ʌɸɞɢ ɡ ɨɛɦɟɠɟɧɧɹɦɢ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɬɚ ʀɯ ɪɨɞɢɧɢ ɡɚɡɧɚɸɬɶ ɥɿɩɲɨɝɨ ɡɞɨɪɨɜ'ɹ ɿ
ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ, ɤɨɥɢ ɜɨɧɢ ɽ ɩɚɪɬɧɟɪɚɦɢ ɜ ɪɟɚɛɿɥɿɬɚɰɿʀ
(3-9)
Ìàëþíîê 3. Âèçíà÷åííÿ ðåàá³ë³òàö³¿ ó Âñåñâ³òí³é äîïîâ³ä³ ç
îáìåæåíü æèòòºä³ÿëüíîñò³ [ÂÄÎÆ]
45
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

ïðîô³ëàêòèêè, ïåðøî÷åðãîâîþ ñòðàòå㳺þ îõîðî- ɉɊ – ɰɟ ɦɭɥɶɬɢ-ɩɪɨɮɟɫɿɣɧɢɣ ɩɿɞɯɿɞ, ʉɪɭɧɬɨɜɚɧɢɣ ɧɚ

íè çäîðîâ’ÿ ñòຠíå ñò³ëüêè ë³êóâàííÿ, ñê³ëüêè îï-
òèì³çàö³ÿ ôóíêö³îíóâàííÿ ëþäåé, ÿê³ æèâóòü äîâ-
øå, àëå ìàþòü çíà÷íî á³ëüø³ îáìåæåííÿ
æèòòºä³ÿëüíîñò³30,31. Àëå öå ïðèðîäíà îáëàñòü ðå-
àá³ë³òàö³¿, ìåòîþ ÿêî¿ º îïòèì³çàö³ÿ âíóòð³øíüîãî
ïîòåíö³àëó çäîðîâ’ÿ ³ ï³äñèëåííÿ ñïðèÿòëèâîñò³ ñå-
ðåäîâèùà, ç òèì ùîá ó âçàºìî䳿 ðåçóëüòàòîì áóëî
á³ëüøå ôóíêö³îíóâàííÿ òà ìåíøå îáìåæåíü æèò-
òºä³ÿëüíîñò³. Ôàêòè÷íî, äåìîãðàô³÷í³ òà åï³äåì³-
îëîã³÷í³ ðåà볿 ñîö³àëüíî òðàíñôîðìóâàëè ðåàá³ë³-
òàö³þ â îñíîâíó ñòðàòåã³þ îõîðîíè çäîðîâ’ÿ ÕÕ²
ñòîë³òòÿ 32.
Âèçíà÷åííÿ ðåàá³ë³òàö³¿ íà îñíîâ³ ÌÊÔ
Ïðèéíÿòòÿ ̳æíàðîäíî¿ êëàñèô³êàö³¿ ôóíêö³îíó-
âàííÿ, îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ
(ÌÊÔ)4 çàáåçïå÷èëî îñíîâó äëÿ ïåðåîñìèñëåííÿ
ðåàá³ë³òàö³¿ ÿê ñòðàòå㳿 â ãàëóç³ îõîðîíè çäîðîâ’ÿ
òà ïîñòàâèëî ðåàá³ë³òàö³þ íà ì³öí³øó êîíöåïòóàëü-
íó îñíîâó. Íåçíà÷íî ìîäèô³êîâàíà ÷àñòèíà çàñíî-
ɞɨɤɚɡɚɯ, ɹɤɢɣ ɧɚɞɚɽɬɶɫɹ ɜ ɪɿɡɧɢɯ ɡɚɤɥɚɞɚɯ, ɫɥɭɠɛɚɯ
ɿ ɡɚɯɨɞɚɯ ɞɥɹ ɨɫɿɛ ɩɪɚɰɟɡɞɚɬɧɨɝɨ ɜɿɤɭ, ɳɨ ɦɚɸɬɶ
ɩɨɪɭɲɟɧɧɹ, ɩɨɜ'ɹɡɚɧɿ ɡɿ ɡɞɨɪɨɜ'ɹɦ, ɨɛɦɟɠɟɧɧɹ ɚɛɨ
ɡɧɢɠɟɧɧɹ ɬɪɭɞɨɜɨɝɨ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ, ɿ ɨɫɧɨɜɧɨɸ ɦɟɬɨɸ
ɹɤɨɝɨ ɽ ɨɩɬɢɦɿɡɚɰɿɹ ʀɯ ɭɱɚɫɬɿ ɜ ɬɪɭɞɿ.
Ìàëþíîê 4. Ïðîïîíîâàíå êîíöåïòóàëüíå âèçíà÷åííÿ ïðîôåñ-
³éíî¿ ðåàá³ë³òàö³¿ (ÏÐ) íà îñíîâ³ ÌÊÔ
âàíîãî íà ÌÊÔ êîíöåïòóàëüíîãî îïèñó ðåàá³ë³òàö³¿,
îïóáë³êîâàíîãî â 2007 ðîö³ Êîì³òåòîì ïðîôåñ³éí³é
ïðàêòèö³ Ñåêö³¿ ÔÐÌ ªÑÌÑ14, áóëà âèêîðèñòàíà
â ÿêîñò³ âèçíà÷åííÿ ðåàá³ë³òàö³¿ ó Âñåñâ³òí³é äî-
ïîâ³ä³ ç îáìåæåíü æèòòºä³ÿëüíîñò³ (ÂÄÎÆ) ÂÎÎÇ,
îïðèëþäíåíî¿ ó 2011 ðîö³33 (Ìàëþíîê 3). Â òîìó
æ ðîö³, ï³ñëÿ ì³æíàðîäíîãî îáãîâîðåííÿ, ISPRM
ðîçðîáèëà òà çàòâåðäèëà îíîâëåíó âåðñ³þ öüîãî
êîíöåïòóàëüíîãî îïèñó (Òàáëèöÿ ²²²)15.
Öåé êîíöåïòóàëüíèé îïèñ òàêîæ ïîñëóæèâ îñ-
íîâîþ ïîõ³äíèõ êîíöåïòóàë³çàö³é äëÿ êîíêðåòíèõ

Òàáëèöÿ IV. ̳æíàðîäíà êëàñèô³êàö³ÿ ôóíêö³îíóâàííÿ, êîíöåïòóàëüíèé îïèñ Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ)

1. Ɏɿɡɢɱɧɚ ɬɚ Ɋɟɚɛɿɥɿɬɚɰɿɣɧɚ Ɇɟɞɢɰɢɧɚ – ɰɟ ɦɟɞɢɱɧɚ ɫɩɟɰɿɚɥɶɧɿɫɬɶ, ɹɤɚ ɫɩɢɪɚɽɬɶɫɹ ɧɚ ɿɧɬɟɝɪɚɬɢɜɧɭ ɦɨɞɟɥɶ

ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ, ɨɛɦɟɠɟɧɧɹ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɬɚ ɡɞɨɪɨɜ’ɹ ȼɈɈɁ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɸ, ɳɨ ɽ ʀʀ ɨɫɧɨɜɧɨɸ ɫɬɪɚɬɟɝɿɽɸ
ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ,
2. ɞɿɚɝɧɨɫɬɭɽ ɫɬɚɧɢ ɡɞɨɪɨɜ'ɹ
3. ɨɰɿɧɸɽ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɜɿɞɧɨɫɧɨ ɞɨ ɫɬɚɧɿɜ ɡɞɨɪɨɜ'ɹ, ɨɫɨɛɢɫɬɢɯ ɮɚɤɬɨɪɿɜ ɬɚ ɮɚɤɬɨɪɿɜ ɫɟɪɟɞɨɜɢɳɚ
4. ɜɢɤɨɧɭɽ, ɡɚɫɬɨɫɨɜɭɽ ɬɚ / ɚɛɨ ɩɪɢɡɧɚɱɚɽ ɛɿɨɦɟɞɢɱɧɿ ɬɚ ɬɟɯɧɨɥɨɝɿɱɧɿ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɥɿɤɭɜɚɧɧɹ ɫɬɚɧɿɜ ɡɞɨɪɨɜ'ɹ ɞɥɹ ɬɨɝɨ, ɳɨɛ
- ɫɬɚɛɿɥɿɡɭɜɚɬɢ, ɩɨɥɿɩɲɭɜɚɬɢ ɚɛɨ ɜɿɞɧɨɜɥɸɜɚɬɢ ɩɨɪɭɲɟɧɿ ɮɭɧɤɰɿʀ ɬɚ ɫɬɪɭɤɬɭɪɢ ɨɪɝɚɧɿɡɦɭ
- ɡɚɩɨɛɿɝɬɢ ɩɨɪɭɲɟɧɧɹɦ ɬɚ ɦɟɞɢɱɧɢɦ ɭɫɤɥɚɞɧɟɧɧɹɦ ɬɚ ɤɟɪɭɜɚɬɢ ɪɢɡɢɤɚɦɢ
- ɤɨɦɩɟɧɫɭɜɚɬɢ ɜɿɞɫɭɬɧɿɫɬɶ ɚɛɨ ɜɬɪɚɬɭ ɮɭɧɤɰɿɣ ɬɚ ɫɬɪɭɤɬɭɪ ɨɪɝɚɧɿɡɦɭ
5. ɨɱɨɥɸɽ ɬɚ ɤɨɨɪɞɢɧɭɽ ɩɪɨɝɪɚɦɢ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɨɩɬɢɦɿɡɚɰɿʀ ɚɤɬɢɜɧɨɫɬɿ ɬɚ ɭɱɚɫɬɿ
- ɭ ɩɚɰɿɽɧɬ-ɰɟɧɬɪɢɱɧɨɦɭ ɩɪɨɰɟɫɿ ɜɢɪɿɲɟɧɧɹ ɩɪɨɛɥɟɦ
- ɭ ɩɚɪɬɧɟɪɫɬɜɿ ɦɿɠ ɨɫɨɛɨɸ ɬɚ ɧɚɞɚɜɚɱɟɦ ɬɚ / ɚɛɨ ɞɨɝɥɹɞɚɱɟɦ ɬɚ ɜ ɪɨɡɭɦɿɧɧɿ ɫɩɪɢɣɧɹɬɬɹ ɨɫɨɛɨɸ ɣɨɝɨ ɚɛɨ ʀʀ ɦɿɫɰɹ ɜ
ɠɢɬɬɿ
- ɜɢɤɨɧɭɸɱɢ, ɡɚɫɬɨɫɨɜɭɸɱɢ ɬɚ ɿɧɬɟɝɪɭɸɱɢ ɛɿɨɦɟɞɢɱɧɿ ɬɚ ɬɟɯɧɨɥɨɝɿɱɧɿ, ɩɫɢɯɨɥɨɝɿɱɧɿ ɬɚ ɩɨɜɟɞɿɧɤɨɜɿ ɜɬɪɭɱɚɧɧɹ,
ɧɚɜɱɚɥɶɧɿ ɬɚ ɤɨɧɫɭɥɶɬɚɰɿɣɧɿ, ɡɚɧɹɬɬɽɜɿ ɬɚ ɩɪɨɮɟɫɿɣɧɿ, ɫɨɰɿɚɥɶɧɿ ɬɚ ɩɿɞɬɪɢɦɭɸɱɿ ɜɬɪɭɱɚɧɧɹ, ɚ ɬɚɤɨɠ ɜɬɪɭɱɚɧɧɹ,
ɫɩɪɹɦɨɜɚɧɿ ɧɚ ɮɿɡɢɱɧɟ ɫɟɪɟɞɨɜɢɳɟ
6. ɧɚɞɚɽ ɩɨɪɚɞɢ ɩɚɰɿɽɧɬɚɦ ɬɚ ʀɯ ɧɚɣɛɥɢɠɱɨɦɭ ɫɨɰɿɚɥɶɧɨɦɭ ɫɟɪɟɞɨɜɢɳɭ, ɩɨɫɬɚɱɚɥɶɧɢɤɚɦ ɩɨɫɥɭɝ ɬɚ ɩɥɚɬɧɢɤɚɦ
- ɩɪɨɬɹɝɨɦ ɩɟɪɟɛɿɝɭ ɫɬɚɧɭ ɡɞɨɪɨɜ'ɹ,
- ɞɥɹ ɜɫɿɯ ɜɿɤɨɜɢɯ ɝɪɭɩ
- ɜɩɪɨɞɨɜɠ ɬɚ ɱɟɪɟɡ ɤɨɧɬɢɧɭɭɦ ɞɨɩɨɦɨɝɢ,
- ɜɤɥɸɱɚɸɱɢ ɥɿɤɚɪɧɿ, ɪɟɚɛɿɥɿɬɚɰɿɣɧɿ ɡɚɤɥɚɞɢ ɬɚ ɝɪɨɦɚɞɢ,
- ɿ ɦɿɠ ɫɟɤɬɨɪɚɦɢ
- ɜɤɥɸɱɚɸɱɢ ɨɯɨɪɨɧɭ ɡɞɨɪɨɜ'ɹ, ɨɫɜɿɬɭ, ɩɪɚɰɸ ɬɚ ɫɨɰɿɚɥɶɧɿ ɜɿɞɧɨɫɢɧɢ;
7. ɡɚɛɟɡɩɟɱɭɽ ɨɫɜɿɬɭ ɩɚɰɿɽɧɬɿɜ, ɪɨɞɢɱɿɜ ɬɚ ɿɧɲɢɯ ɜɚɠɥɢɜɢɯ ɨɫɿɛ ɞɥɹ ɩɪɨɦɨɬɭɜɚɧɧɹ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɬɚ ɡɞɨɪɨɜ'ɹ
8. ɭɩɪɚɜɥɹɽ ɪɟɚɛɿɥɿɬɚɰɿɽɸ ɬɚ ɨɯɨɪɨɧɨɸ ɡɞɨɪɨɜ'ɹ ɭ ɜɫɿɯ ɫɮɟɪɚɯ ɩɨɫɥɭɝ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ
9. ɿɧɮɨɪɦɭɽ ɬɚ ɤɨɧɫɭɥɶɬɭɽ ɝɪɨɦɚɞɫɶɤɿɫɬɶ ɬɚ ɨɫɿɛ, ɳɨ ɭɯɜɚɥɸɸɬɶ ɪɿɲɟɧɧɹ, ɳɨɞɨ ɜɿɞɩɨɜɿɞɧɨʀ ɩɨɥɿɬɢɤɢ ɬɚ ɩɪɨɝɪɚɦ ɭ ɫɟɤɬɨɪɿ
ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ ɬɚ ɿɧɲɢɯ ɫɟɤɬɨɪɚɯ, ɹɤɿ
- ɡɚɛɟɡɩɟɱɭɸɬɶ ɬɚ ɡɛɿɥɶɲɭɸɬɶ ɫɩɪɢɹɬɥɢɜɟ ɮɿɡɢɱɧɟ ɬɚ ɫɨɰɿɚɥɶɧɟ ɫɟɪɟɞɨɜɢɳɟ;
- ɡɚɛɟɡɩɟɱɭɸɬɶ ɞɨɫɬɭɩɧɿɫɬɶ ɞɨ ɪɟɚɛɿɥɿɬɚɰɿɣɧɢɯ ɩɨɫɥɭɝ, ɹɤ ɩɪɚɜɚ ɥɸɞɢɧɢ;
- ɿ ɩɿɞɫɢɥɸɸɬɶ ɮɚɯɿɜɰɿɜ ɎɊɆ ɡ ɧɚɞɚɧɧɹ ɫɜɨɽɱɚɫɧɨʀ ɬɚ ɟɮɟɤɬɢɜɧɨʀ ɞɨɩɨɦɨɝɢ
10. ɡ ɰɿɥɥɸ
- ɭɦɨɠɥɢɜɥɟɧɧɹ ɨɫɨɛɚɦ ɡɿ ɫɬɚɧɚɦɢ ɡɞɨɪɨɜ'ɹ, ɹɤɿ ɡɚɡɧɚɸɬɶ, ɚɛɨ ɦɨɠɭɬɶ ɡɚɡɧɚɬɢ ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ, ɞɨɫɹɝɬɢ ɬɚ
ɩɿɞɬɪɢɦɚɬɢ ɨɩɬɢɦɚɥɶɧɟ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ ɭ ɜɡɚɽɦɨɞɿʀ ɡɿ ɫɜɨʀɦ ɫɟɪɟɞɨɜɢɳɟɦ
Ɍɟɪɦɿɧɢ ɆɄɎ ɩɨɡɧɚɱɟɧɿ ɠɢɪɧɢɦ ɲɪɢɮɬɨɦ, ɪɹɞɤɢ ɧɭɦɟɪɭɸɬɶɫɹ ɤɭɪɫɢɜɨɦ.
ȼɈɈɁ: ȼɫɟɫɜɿɬɧɹ ɨɪɝɚɧɿɡɚɰɿɹ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ.
ɡ: Gutenbrunner C, Meyer T, Melvin J, Stucki G. Towards a conceptual description of Physical and Rehabilitation Medicine.
Journal of Rehabilitation Medicine. 2011;43(9):760-4. Table I p. 762.

46 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018

çàñòîñóâàíü. Çîêðåìà, äëÿ ìåäè÷íî¿ ñïåö³àëüíîñò³
ÔÐÌ áóëà ðîçðîáëåíà ïîõ³äíà âåðñ³ÿ, ñïî÷àòêó ó
âèãëÿä³ âåðñ³¿ äëÿ ì³æíàðîäíîãî îáãîâîðåííÿ34, à
ïîò³ì ïåðåãëÿíóòî¿ âåðñ³¿, ñõâàëåíî¿ ISPRM ó 2011
ðîö³ (Òàáëèöÿ IV) 16. Öåé êîíöåïòóàëüíèé îïèñ
ìîæå ñëóãóâàòè äëÿ ðîçðîáêè ïîõ³äíèõ êîíöåïö³é
äëÿ êîíêðåòíèõ îáëàñòåé ÔÐÌ, íàïðèêëàä, äëÿ
ðåàá³ë³òàö³¿, ùî ôîêóñóºòüñÿ íà êîíêðåòíèõ ñèñòå-
ìàõ îðãàí³â àáî ñòàíàõ çäîðîâ’ÿ. Íàðåøò³, äðóãèé
ïîõ³äíèé êîíöåïòóàëüíèé îïèñ áóâ ðîçðîáëåíèé äëÿ
ïðîôåñ³éíî¿ ðåàá³ë³òàö³¿ (ÏÐ) (Ìàëþíîê 4)35.
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ÐÎÇÄ²Ë 1 – ÂÈÇÍÀ×ÅÍÍß ÒÀ ÏÎÍßÒÒß ÔÐÌ
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13;48(6):486–93.
33. WHO, World Bank. World Report on Disability. 2011.
47
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

34. Stucki G., Melvin J. The International Classification of 35. Escorpizo R., Reneman M.F., Ekholm J., Fritz J., Krupa T.,
Functioning, Disability and Health: a unifying model for the Marnetoft S-U, et al. A conceptual definition of vocational
conceptual description of physical and rehabilitation medicine. rehabilitation based on the ICF: building a shared global model.
J Rehabil Med. 2007 May;39(4):286–92. J. Occup. Rehabil. 2011 Jun;21(2):126–33.

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Pedro Cantista,
Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner, Carlotte Kiekens,
Sasa Moslavac, Enrique Varela-Donoso, Anthony B Ward, Mauro Zampolini, Stefano Negrini.
• Ó÷àñíèêè: Pedro Cantista, Gerold Stucki, Jerome Bickenbach, Christoph Gutenbrunner, António Pinto
Camelo, Carlotte Kiekens, Juan Carlos Miangollara, Daiana Popa, Francisco Sampaio, Pedro Soares Branco.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ.

48 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐM) â ªâðîï³
Ðîçä³ë 2 – ×îìó ðåàá³ë³òàö³ÿ ïîòð³áíà ³íäèâ³äóóìó
òà ñóñï³ëüñòâó
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
Ó êîíòåêñò³ Á³ëî¿ Êíèãè Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ) â ªâðîï³ öåé äîêóìåíò îïèñóº ï³äîñíîâè êîíòåê-
ñòó ïîñëóã ÔÐÌ òà âêëþ÷ຠíàñòóïíå:
– Åï³äåì³îëîã³÷í³ àñïåêòè ôóíêö³îíóâàííÿ òà îáìåæåííÿ æèòòºä³ÿëüíîñò³
– Åòè÷í³ àñïåêòè òà ïðàâà ëþäèíè
– Ðåàá³ë³òàö³ÿ òà ñèñòåìè îõîðîíè çäîðîâ’ÿ
– Åêîíîì³÷íèé òÿãàð îáìåæåíü æèòòºä³ÿëüíîñò³
– Âïëèâ â³äñóòíîñò³ ðåàá³ë³òàö³¿
Ïëàíóâàííÿ ïîñëóã â îõîðîíè çäîðîâ’ÿ âèçíà÷ຠòÿãàð îáìåæåíü æèòòºä³ÿëüíîñò³ äëÿ ñóñï³ëüñòâà, ³ öåé ðîçä³ë îïèñóº
îá´ðóíòóâàííÿ ñïåö³àë³çîâàíî¿ ðåàá³ë³òàö³¿, ï³äîñíîâè ÔÐÌ, à òàêîæ ÷îìó îñíîâíîþ êîìïåòåíö³ºþ º ôóíêö³îíàëüíèé
ä³àãíîç òà îðãàí³çàö³éíèé ïëàí, ÿêèé ´ðóíòóºòüñÿ íà ôóíêö³¿.
Ðîçä³ë îïèñóº çá³ëüøåííÿ òÿãàðÿ îáìåæåíü æèòòºä³ÿëüíîñò³ âíàñë³äîê óìîâ, ùî ñïîñòåð³ãàþòüñÿ â ïðàêòèö³ ÔÐÌ, à íå
ïðè âñ³õ òèõ çàõâîðþâàííÿõ, ùî ïðèçâîäÿòü äî ô³çè÷íèõ îáìåæåíü, ³ íå âêëþ÷ຠïñèõ³÷í³ çàõâîðþâàííÿ, îáìåæåííÿ
æèòòºä³ÿëüíîñò³ ùîäî íàâ÷àííÿ òîùî. 10% íàñåëåííÿ Çàõ³äíî¿ ªâðîïè ìàþòü îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà äîâøå
âèæèâàþòü, ùî ïðèçâîäèòü äî çá³ëüøåííÿ âèòðàò íà îõîðîíó çäîðîâ’ÿ òà ñîö³àëüíó äîïîìîãó òà á³ëüøîãî âïëèâó
ñóïóòí³õ çàõâîðþâàíü. Ðîçä³ë òàêîæ îïèñóº âïëèâ ³ çá³ëüøåííÿ âèòðàò ïðè â³äñóòíîñò³ ðåàá³ë³òàö³¿. Íå ò³ëüêè ãðîø³,
âèòðà÷åí³ íà ðåàá³ë³òàö³þ, â³äíîâëþþòüñÿ ç ï’ÿòè-äåâ’ÿòè êðàòíèìè çàîùàäæåííÿìè (íàïð. ÷åðåç ïîâåðíåííÿ äî ïðàö³),
àëå é ðåàá³ë³òàö³ÿ åôåêòèâíà âïðîäîâæ óñ³õ ôàç ñòàí³â çäîðîâ’ÿ. Ñïåö³àë³çîâàíà ðåàá³ë³òàö³ÿ (òà, ùî íàäàºòüñÿ ñëóæáîþ
ÔÐÌ) º âèñîêîðåíòàáåëüíîþ äëÿ âñ³õ íåâðîëîã³÷íèõ ñòàí³â, çàáåçïå÷óþ÷è ³ñòîòíó åêîíîì³þ âèòðàò íà ïîòî÷íå ë³êó-
âàííÿ, îñîáëèâî ó ïàö³ºíò³â ç âèñîêèì ð³âíåì çàëåæíîñò³.
Äèñêðèì³íàö³ÿ çà îáìåæåííÿìè æèòòºä³ÿëüíîñò³ º íåçàêîííîþ, òà äàíèé òåêñò îïèñóº, ÿêèì º ïðàâîâèé êîíòåêñò ëþäèíè
ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³, ÿêà æèâå â ªâðîï³. Äðóãà ÷àñòèíà âèñâ³òëþº Êîíâåíö³¿ Îðãàí³çàö³¿ Îá’ºäíàíèõ Íàö³é
ïðî ïðàâà ëþäèíè, ï³äòâåðäæåí³ ó Âñåñâ³òí³é äîïîâ³ä³ ç îáìåæåíü æèòòºä³ÿëüíîñò³, àëå òàêîæ, ïðèíöèïè åòè÷íî¿ ïðàê-
òèêè ñåðåä ë³êàð³â ÔÐÌ.
Òðåòÿ ÷àñòèíà àäðåñîâàíà äî âàð³àáåëüíîñò³ äîñòóïó äî òà ô³íàíñóâàííÿ ðåàá³ë³òàö³éíèõ ïîñëóã ó ð³çíèõ êðà¿íàõ.
Ðîçä³ë òàêîæ â³äîêðåìëþº âèñîêîñïåö³àë³çîâàí³ âòðó÷àííÿ (òàê³, ùî íàäàþòüñÿ ë³êàðåì ÔÐÌ) â³ä ñïåö³àë³çîâàíèõ
âòðó÷àíü (òàêèõ, ÿê ìåíåäæìåíò ïðîëåæí³â) òà çàãàëüíèõ âòðó÷àíü (íàïð. ï³ñëÿ íåóñêëàäíåíîãî ïåðåëîìó ê³íö³âîê). Öå
áóäå âàæëèâî äëÿ îðãàí³â îõîðîíè çäîðîâ’ÿ, îðãàí³çàö³é ãðîìàäñüêîãî çäîðîâ’ÿ, ïëàòíèê³â, íàäàâà÷³â, ïðîôåñ³îíàë³â
îõîðîíè çäîðîâ’ÿ, ñïîæèâà÷³â òà ãðîìàäè.
Åêîíîì³÷íèé òà ñîö³àëüíèé òÿãàð îáìåæåíü æèòòºä³ÿëüíîñò³ äëÿ ñóñï³ëüñòâà º çíà÷íèì ³ íàäàë³ áóäå ïîã³ðøóâàòèñü,
õî÷à öå âàæêî âèçíà÷èòè ê³ëüê³ñíî. Ïðÿì³ âèòðàòè âàð³þþòü òà âêëþ÷àþòü äîäàòêîâ³ âèòðàòè íà ïîâñÿêäåííå æèòòÿ
îñîáàì ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà äåðæàâíó äîïîìîãó ç îáìåæåíü æèòòºä³ÿëüíîñò³. Ðåàá³ë³òàö³ÿ ìຠíàéâàæëè-
â³øó ðîëü ó çíèæåíí³ öèõ âèòðàò øëÿõîì ñïðèÿííÿ îñîáèñòîìó â³äíîâëåííþ òà çá³ëüøåííþ ôóíêö³é øëÿõîì âïëèâó íà
ôàêòîðè ñåðåäîâèùà. Öÿ ÷àñòèíà îïèñóº äîñë³äæåííÿ ç åêîíî쳿 êîøò³â øëÿõîì ðåàá³ë³òàö³¿ îñ³á ç âàæêèìè îáìåæåííÿ-
ìè æèòòºä³ÿëüíîñò³.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine in Europe.Chapter 2. Why rehabilitation is needed by individual andsociety. Eur J Phys
Rehabil Med. 2018 Apr;54(2):166-176.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 2. ×îìó ðåàá³ë³òàö³ÿ ïîòð³áíà ³íäèâ³äóóìó òà
ñóñï³ëüñòâó. Óêðà¿íñüêèé æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 49–60.
Êëþ÷îâ³ ñëîâà: Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà; ªâðîïà; Òÿãàð îáìåæåíü æèòòºä³ÿëüíîñò³; Åêîíîì³êà; Ïðàâà
ëþäèíè; ðåàá³ë³òàö³éí³ âèòðàòè òà âïëèâ ðåàá³ë³òàö³¿.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 49
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Ââåäåííÿ
Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî
óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³î-
íàëüíîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòå-
ð³àë³â äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìó-
âàííÿ ïðî ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â
ðåàá³ë³òàö³¿ òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà
âàæëèâîñò³ ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ ñïå-
ö³àëüí³ñòþ. Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïîíÿò-
òÿ ÔÐÌ, ÷îìó ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì ëþ-
äÿì ³ ñóñï³ëüñòâó, îñíîâè ÔÐÌ, ³ñòîð³ÿ
ñïåö³àëüíîñò³ ÔÐÌ, ñòðóêòóðà ³ ä³ÿëüí³ñòü îðãàí³-
çàö³é ÔÐÌ â ªâðîï³, çíàííÿ ³ íàâè÷êè ë³êàð³â ÔÐÌ,
ñôåðà êë³í³÷íèõ êîìïåòåíòíîñòåé ÔÐÌ, ì³ñöå
ñïåö³àëüíîñò³ ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ ³
ñóñï³ëüñòâ³, îñâ³òà òà áåçïåðåðâíèé ïðîôåñ³éíèé
ðîçâèòîê ë³êàð³â ÔÐÌ, îñîáëèâîñò³ òà ïðîáëåìè
íàóêè òà äîñë³äæåíü â ÔÐÌ òà ïðîáëåìè òà ïåð-
ñïåêòèâè ìàéáóòíüîãî ÔÐÌ.
Öåé ðîçä³ë îïèñóº ï³äîñíîâè êîíòåêñòó ïîñëóã
ÔÐÌ. Áóäü-ÿêå ïëàíóâàííÿ îñòàííüî¿ ìຠâðàõî-
âóâàòè òÿãàð îáìåæåíü æèòòºä³ÿëüíîñò³ ñåðåä
ñóñï³ëüñòâà, à öåé ðîçä³ë äຠîãëÿä ñèòóàö³¿ íå
ò³ëüêè â ªâðîï³, àëå òàêîæ ³ â ö³ëîìó ñâ³ò³. Ôàõ³âö³
ÔÐÌ ïîâèíí³ áóòè çâ’ÿçàí³ ç öèì êîíòåêñòîì òà
âì³òè çàñòîñîâóâàòè éîãî, ùî äîçâîëèòü ¿ì ïðàöþ-
âàòè â ðàìêàõ ñòàíäàðò³â, ïðèéíÿòèõ äëÿ ñïåö³àëü-
íîñò³. ²íø³ ë³êàð³, ïðîôåñ³îíàëè îõîðîíè çäîðîâ’ÿ
òà ìåíåäæåðè òàêîæ ïîâèíí³ çíàòè ï³äîñíîâè ÔÐÌ
³ ÷îìó âèçíà÷åííÿ ôóíêö³îíàëüíîãî ä³àãíîçó òà
îðãàí³çàö³éíîãî ïëàíó, ÿêèé ´ðóíòóºòüñÿ íà ôóíêö³¿,
º êëþ÷îâèì åëåìåíòîì êîìïåòåíòîñò³ ÔÐÌ.
Åï³äåì³îëîã³÷í³ àñïåêòè
Äåìîãðàô³÷í³ çì³íè â ªâðîï³
Íàñåëåííÿ ªâðîïè íå ò³ëüêè çðîñòàº, à é íåùî-
äàâíî â³äáóëàñÿ ïîäàëüøà åêñïàíñ³ÿ â³ä âåëèêî¿
ê³ëüêîñò³ ì³ãðàíò³â. Öèôðè 2013 ðîêó âêàçóþòü íà
çàãàëüíå ÷èñëî ó 742,5 ì³ëüéîí³â æèòåë³â, ç ÿêèõ 510
ì³ëüéîí³â ïðîæèâàþòü ó 28 êðà¿íàõ-÷ëåíàõ ªâðî-
ïåéñüêîãî Ñîþçó. ªâðîïåéñüêèé Ñîþç Ìåäè÷íèõ
Ñïåö³àë³ñò³â (ªÑÌÑ) âêëþ÷ຠâ ñåáå Âåëèêèé
ªâðîïåéñüêèé Ïðîñò³ð ç 31 êðà¿íîþ-÷ëåíàìè ªÑ,
à òàêîæ Øâåéöàð³ºþ, Íîðâå㳺þ, ²ñëàí䳺þ. Òó-
ðå÷÷èíà, ²çðà¿ëü òà Ñåðá³ÿ º àñîö³éîâàíèìè ÷ëåíà-
ìè, îäíàê Ñåêö³ÿ ÔÐÌ ªÑÌÑ òàêîæ ìຠêðà¿íè-
ñïîñòåð³ãà÷³ (Áîñí³ÿ ³ Ãåðöåãîâèíà, Ìîíòåíåãðî,
Ìàêåäîí³ÿ, Ãðóç³ÿ, ³ðìåí³ÿ, Ðîñ³ÿ òà Óêðà¿íà).
50 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ªÑÌÑ ïðàãíå âêëþ÷èòè ³íø³ êðà¿íè ç³ Ñõ³äíî¿
ªâðîïè òà êðà¿íè, ùî ìåæóþòü ç À糺þ, òàê³ ÿê
Á³ëîðóñü, Êàçàõñòàí òà Àçåðáàéäæàí.
Òàêèì ÷èíîì, çàãàëüíà ÷èñåëüí³ñòü íàñåëåííÿ
çðîñòຠäî 851,6 ìëí. îñ³á çà äàíèìè îñòàííüî¿
ñòàòèñòèêè (2016 ð.). Î÷³êóâàíà òðèâàë³ñòü æèòòÿ
ñåðåä ºâðîïåéö³â òàêîæ çðîñòàº. Íàïðèêëàä, â
ͳìå÷÷èí³ âîíà çðîñëà ìàéæå íà 3 ðîêè â ïåð³îä
ì³æ 1990 òà 2000 ðîêàìè, òà, äî 2030 ðîêó, îö³-
íþºòüñÿ, øî êîæíà ÷åòâåðòà ëþäèíà áóäå â³êîì
65 ðîê³â àáî ñòàðøå1,2. Äîäàòêîâî äî ñòàð³ííÿ ïî-
ïóëÿö³¿, ñïîñòåð³ãàºòüñÿ çá³ëüøåííÿ ð³âíÿ îáìå-
æåíü æèòòºä³ÿëüíîñò³, ùî âèðàæàºòüñÿ ó çðîñòàíí³
òÿãàðÿ äîïîìîãè, çá³ëüøåíí³ âèòðàò íà îõîðîíó
çäîðîâ’ÿ òà ñîö³àëüíó äîïîìîãó, à òàêîæ íà
çá³ëüøåííÿ âïëèâó ñóïóòí³õ çàõâîðþâàíü. Áëèçü-
êî 10% íàñåëåííÿ Çàõ³äíî¿ ªâðîïè çàçíàëè îáìå-
æåíü æèòòºä³ÿëüíîñò³, ÿê öå îïèñàíî â áðèòàí-
ñüêîìó îáçîð³3,4.
Íåîáõ³äíî òàêîæ ðîçãëÿíóòè äâà âàæëèâèõ ôàê-
òîðè:
– Âèæèâàííÿ ï³ñëÿ ñåðéîçíèõ çàõâîðþâàíü ³
òðàâì çàëèøຠçðîñòàþ÷ó ê³ëüê³ñòü ëþäåé ç³
ñêëàäíèìè ïðîáëåìàìè ôóíêö³îíàëüíîãî äåô³-
öèòó.
– Áàãàòî õòî ç öèõ ëþäåé º ìîëîäèìè ï³ä ÷àñ
âèïàäêó / òðàâìè ³ áóäóòü æèòè ïðîòÿãîì áà-
ãàòüîõ äåñÿòèë³òü5,6.
Ïðèêëàäè º ÷èñëåííèìè, íàïð. ³íñóëüò, ÷åðåï-
íî-ìîçêîâà òðàâìà, ïîë³òðàâìà òà ðàê â äèòÿ÷î-
ìó â³ö³, äå êðàùå îðãàí³çîâàíà ãîñòðà äîïîìîãà òà
ðåàá³ë³òàö³ÿ ïðèçâåëè äî á³ëüøîãî âèæèâàííÿ ³ êðà-
ùèõ ðåçóëüòàò³â7-16.
 ñó÷àñíîìó ñóñï³ëüñòâ³ òàêîæ ³ñíóº î÷³êóâàí-
íÿ õîðîøîãî çäîðîâ’ÿ. Öå ñòàâèòü äîäàòêîâ³ âè-
ìîãè äî âñ³º¿ îõîðîíè çäîðîâ’ÿ, âêëþ÷àþ÷è ë³êàð³â
ÔÐÌ. Ìàòè ñïðàâó ç íàñë³äêàìè çàõâîðþâàíü ³
òðàâì, òàêèìè, ÿê ñïàñòè÷í³ñòü ï³ñëÿ óðàæåíü ãî-
ëîâíîãî àáî ñïèííîãî ìîçêó îçíà÷àº, ùî öå íå
ò³ëüêè ïîêðàùåííÿ æèòòÿ ïàö³ºíò³â, àëå é âèãîäà
äëÿ åêîíîì³êè îõîðîíè çäîðîâ’ÿ çà ðàõóíîê çíèæåí-
íÿ âèòðàò íà ë³êóâàííÿ öèõ óñêëàäíåíü. Öå ìàòè-
ìå ïðÿìèé âïëèâ íà íàäàííÿ äîïîìîãè, òðóäîâå
æèòòÿ òà ïåíñ³¿12,13,17. Çîêðåìà, òàê³ ïðîáëåìè, ÿê
çíåðóõîìëåí³ñòü, á³ëü, õàð÷óâàííÿ, íåòðèìàííÿ,
ïîðóøåííÿ êîìóí³êàö³¿, ðîçëàäè íàñòðîþ ³ ïîâåä³-
íêè ñòàþòü âàæëèâèìè â äîïîâíåíí³ äî ñèñòåìíèõ
õâîðîáè òà äî óñêëàäíåíü ³ñíóþ÷èõ ñòàí³â, ùî
ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³. Ðåàá³-
ë³òàö³ÿ º åôåêòèâíîþ â çìåíøåíí³ òÿãàðÿ îáìå-
æåíü æèòòºä³ÿëüíîñò³ òà ðîçøèðåíí³ ìîæëèâîñòåé
äëÿ ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³. ª
äîêàçè, ùî öå ìîæå áóòè ìåíø çàòðàòíèì, í³æ
â³äñóòí³ñòü íàäàííÿ òàêî¿ äîïîìîãè 17. ²ñíóþòü
ïåðåêîíëèâ³ äîêàçè òîãî, ùî ïîïåðåäæåííÿ óñêëàä-
¹2(2) *2018
 ÐÎÇÄ²Ë 2 – ×ÎÌÓ ÐÅÀÁ²Ë²ÒÀÖ²ß ÏÎÒвÁÍÀ ²ÍÄȲÄÓÓÌÓ ÒÀ ÑÓÑϲËÜÑÒÂÓ
íåíü çíåðóõîìëåíîñò³ (íàïð. ïðîëåæí³ ³ êîíòðàê-
òóðè), ÷åðåïíî-ìîçêîâèõ òðàâì (íàïð. ïîâåä³íêîâ³
ïðîáëåìè) òà áîëþ (íàïð. çì³íè íàñòðîþ) ìîæóòü
ïðèçâåñòè äî áàãàòüîõ ïåðåâàã17.
Åï³äåì³îëîã³ÿ ôóíêö³îíóâàííÿ òà îáìåæåíü
æèòòºä³ÿëüíîñò³
Åï³äåì³îëîã³÷í³ äîñë³äæåííÿ òðàäèö³éíî ´ðóíòó-
âàëè ñâîþ ìåòîäîëîã³þ íà ïàòîëîã³ÿõ.  äàíèé ÷àñ
âîíè ïî÷àëè ðîçãëÿäàòè õðîí³÷íó õâîðîáó, ÿê
ñóá’ºêò, àëå ùå íå ðîçãëÿíóëè íàëåæíèì ÷èíîì
êîíöåïö³¿ ôóíêö³îíóâàííÿ, ó÷àñò³ òà ÿêîñò³ æèòòÿ
îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³, ÿê ïîïóëÿö³¿.
Ñó÷àñíèé ï³äõ³ä ïîëÿãຠó âèð³øåíí³ öèõ ïðîáëåì,
çîñåðåäæóþ÷è óâàãó íà Î÷³êóâàí³é Òðèâàëîñò³
Æèòòÿ â Çäîðîâîìó ñòàí³ (ÒÆÇ, Healthy Life
Expectancy – HALE) òà Ðîêè Æèòòÿ, Ñêîðèãîâàí³
ç Îáìåæåííÿìè Æèòòºä³ÿëüíîñò³ (ÐÆÑÎÆ,
Disability-Adjusted Life-Years – DALYs). Öå – ñó-
ìàðí³ ïîêàçíèêè ïîïóëÿö³éíîãî çäîðîâ’ÿ, ÿê³ ïî-
ºäíóþòü ³íôîðìàö³þ ïðî ñìåðòí³ñòü òà íåôàòàëüí³
ðåçóëüòàòè çäîðîâ’ÿ äëÿ äåìîíñòðàö³¿ çäîðîâ’ÿ íà-
ñåëåííÿ â îäíîìó ÷èñë³. Äîäàòêîâî äî çàõâîðþ-
âàíîñò³ òà ïîøèðåíîñò³ íàé÷àñò³øèõ ïàòîëîã³é â
ïåâí³é îáëàñò³ (³íñóëüòè, óðàæåííÿ ñïèííîãî ìîç-
êó, ÷åðåïíî-ìîçêîâ³ òðàâìè, àìïóòàö³¿, ðåâìàòî-
ëîã³÷í³ çàõâîðþâàííÿ, ³íø³ íåâðîëîã³÷í³, àáî ì’ÿ-
çîâî-ñêåëåòí³ ñòàíè, áîë³ òîùî), åï³äåì³îëîã³ÿ ó
ÔÐÌ ïîâèííà âðàõîâóâàòè:
– ðåçóëüòóþ÷ó âòðàòó ôóíêö³îíóâàííÿ ç òî÷êè
çîðó êàòåãîð³é ÌÊÔ;
– ïðèðîäíèé ðîçâèòîê ôóíêö³é, àêòèâíîñò³ òà
ó÷àñò³;
– ïîòðåáó â òà äîñòóï äî ðåñóðñ³â äëÿ âèêîðèñ-
òàííÿ â ðåàá³ë³òàö³¿ (ëþäñüê³ ðåñóðñè, çàêëàäè,
îáëàäíàííÿ, ìàòåð³àëè);
– äîñòóï äî íàÿâíèõ ðåñóðñ³â ÔÐÌ.
Òàêà ³íôîðìàö³ÿ äîïîìàãຠïëàíóâàííþ òà âèç-
íà÷åííþ ïð³îðèòåò³â ðåã³îíàëüíèõ, íàö³îíàëüíèõ òà
ºâðîïåéñüêèõ ïîñëóã, ô³íàíñóâàííþ äîñë³äæåíü òà
ðîçâèòêó íàâ÷àííÿ øëÿõîì íàäàííÿ ³íôîðìàö³¿ ïðî
åôåêòèâí³ñòü òà ö³íó-åôåêòèâí³ñòü âòðó÷àíü ÔÐÌ.
ª áàãàòî ñâ³ä÷åíü, ùî íàäàþòü ³íôîðìàö³þ ùîäî
÷àñòîòè òà ïîøèðåíîñò³ îñíîâíèõ ñòàí³â, ÿê³ ïðè-
çâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³ òà ñïîñòå-
ð³ãàþòüñÿ â ïðàêòèö³ ÔÐÌ. Äåÿê³ ïðèêëàäè íàâå-
äåí³ ó Äîäàòêó 3. ÔÐÌ îñîáëèâî ñòóðáîâàíà ¿õ
âïëèâîì. ßê ïðèêëàä, ìè ìîæåìî øóêàòè ðåçóëü-
òàòè íåùîäàâíüîãî îïèòóâàííÿ â Ïîðòóãà볿, äå ïî-
â³äîìëÿëîñÿ, ÿêíàéìåíø 0,7% âñüîãî íàñåëåííÿ
ïðèêóòî äî ë³æêà; 0,4% – îáìåæåí³ ñèä³ííÿì (ïî-
òðåáóþòü â³çê³â); 1,9% íå æèëè ó âëàñíèõ äîì³â-
êàõ; 9,0% íå õîäèëè àáî ìàëè ñóòòºâ³ îáìåæåííÿ
ïðè õîäüá³; 8,5% – îáìåæåí³ ïðè ïåðåñóâàíí³ äî òà
ç ë³æêà; 6.2% íå ìîãëè êîðèñòóâàòèñÿ òóàëåòîì
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
áåç ñòîðîííüî¿ äîïîìîãè; 8,6% ïîòðåáóâàëè ñòî-
ðîííüî¿ äîïîìîãè ïðè îäÿãàíí³ àáî ðîçäÿãàíí³;
3,6% ÷îëîâ³ê³â òà 5,3% æ³íîê ìàëè íåòðèìàííÿ
ñå÷³; á³ëÿ 2,3% ìàëè óòðóäíåííÿ ç ìîâîþ. Çàãàëü-
íà ïîøèðåí³ñòü óñ³õ îáìåæåíü æèòòºä³ÿëüíîñò³ â
ãðîìàä³ ñòàíîâèëà 10%55.
ϳäñóìîâóþ÷è, åï³äåì³îëîã³÷í³ äàí³ ï³äòðèìó-
þòü òÿãàð äîâãîòðèâàëèõ ñòàí³â ñåðåä íàñåëåííÿ
ªâðîïè òà ï³äêðåñëþþòü ïîòðåáó â ðåàá³ë³òàö³¿ ó
ªâðîï³. Ñïåöèô³÷í³ åï³äåì³îëîã³÷í³ äàí³, îð³ºíòîâàí³
íà ôóíêö³îíóâàííÿ òà îáìåæåííÿ àêòèâíîñò³, ìà-
þòü âàæëèâå çíà÷åííÿ, ùîá äàòè íàì ïðàâèëüíó
³äåþ ïðî òå, ÿê ìè ïðîãðåñóºìî ó ãëîáàëüí³é ðåà-
á³ë³òàö³éí³é äîïîìîç³. Òàêèì ÷èíîì, ìîæëèâî ïðè-
ïóñòèòè âàæëèâ³ñòü ïîòðåáè â ðåàá³ë³òàö³¿ òà ïî-
òåíö³éíî çíà÷íèé âíåñîê ÔÐÌ ó çíèæåíí³ öüîãî
òÿãàðÿ, à òàêîæ ðîçøèðåííÿ ìîæëèâîñòåé ëþäåé
ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³.
Åòè÷í³ àñïåêòè òà ïðàâà ëþäèíè
Ìåòîþ ö³º¿ ãëàâè º âèñâ³òëåííÿ ñó÷àñíèõ äîñÿã-
íåíü â ï³äòðèìö³ ïðàâ ëþäèíè äëÿ îñ³á ç îáìåæåí-
íÿìè æèòòºä³ÿëüíîñò³, çîêðåìà, êîëè âîíè ïîòðå-
áóþòü ïîðàä òà âòðó÷àíü â³ä ñëóæá ÔÐÌ. Öåé
ðîçä³ë ðîçãëÿäຠäâà àñïåêòè: ïðàâà ëþäèíè ÿê
ñîö³àëüíèé ï³äõ³ä (ìàêðîð³âåíü) òà åòè÷íèé ï³äõ³ä
äî ïðàêòèêè ìåäèöèíè (ì³êðîð³âåíü). Íàñïðàâä³
³ñíóº âçàºìîä³ÿ îáîõ.
Âèñíîâîê ïîëÿãàâ ó òîìó, ùî ïðàâà ëþäèíè
â³ä³ãðàþòü âñå á³ëüøó ðîëü ó áîðîòüá³ çà ãëîáàëü-
íå ïîë³ïøåííÿ çäîðîâ’ÿ òà îõîðîíó çäîðîâ’ÿ. Âîíè
òàêîæ ìàþòü âàæëèâ³ íàñë³äêè äëÿ ïðàêòèê³â ðåà-
á³ë³òàö³¿ òà äîñë³äíèê³â, ³ ïîâèíí³ áóòè ÿäðîì áóäü-
ÿêî¿ åòè÷íî¿ îñíîâè äëÿ ðåàá³ë³òàö³¿. Ìîæëèâî
íàâ³òü ñòâåðäæóâàòè, ùî ïðàâà òà ã³äí³ñòü ñàì³ ïî
ñîá³ º ö³ííèìè ðåçóëüòàòàìè äëÿ ðåàá³ë³òàö³¿.
Öåé ðîçä³ë ñòîñóºòüñÿ ïåðåâàæíî ïðàâ ëþäè-
íè, àëå áóâ âêëþ÷åíèé, ùîá ïîêàçàòè ¿õ ì³ñöå ó
ïðàêòèö³ ÔÐÌ. Ñïåö³àë³ñòè â ö³é ãàëóç³ ïîâèíí³
âèð³øóâàòè åòè÷í³ ïèòàííÿ ùîäî ïðèíöèï³â òà íîðì
íàëåæíî¿ ïðîôåñ³éíî¿ ïîâåä³íêè. Âîíè òàêîæ ïî-
âèíí³ ï³êëóâàòèñÿ ïðî çíàííÿ ïðàâ òà îáîâ’ÿçê³â
ôàõ³âö³â îõîðîíè çäîðîâ’ÿ òà ïðî ¿õíþ ïîâåä³íêó
ùîäî ïàö³ºíò³â òà ìîëîäøèõ êîëåã, âêëþ÷àþ÷è 䳿,
ùî çä³éñíþþòüñÿ ï³ä ÷àñ äîïîìîãè ïàö³ºíòàì òà
÷ëåíàì ¿õ ðîäèí. Âîíè áåðóòü íà ñåáå â³äïîâ³-
äàëüí³ñòü çà äîòðèìàííÿ ñòàíäàðò³â åòè÷íî¿ ïðàê-
òèêè òà ïîâåä³íêè, âñòàíîâëåíèõ ïðîôåñ³ºþ, ³ âîíè
âèêëàäåí³ ó âñ³õ àáî á³ëüøîñò³ ºâðîïåéñüêèõ äåð-
æàâ, (íàïð. “Ãàðíà ìåäè÷íà ïðàêòèêà” – “Good
Medical Practice” – Ãåíåðàëüíî¿ ìåäè÷íî¿ ðàäè
Âåëèêî¿ Áðèòàí³¿). Öå âêëþ÷ຠâ ñåáå åòè÷í³ ïè-
òàííÿ äîïîìîãè ïàö³ºíòàì, ïðîôåñ³éíó êîìàíäíó
ðîáîòó òà äîòðèìàííÿ íîðì îõîðîíè çäîðîâ’ÿ.
51
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Êë³í³öèñòè ïîâèíí³ çâåðòàòè óâàãó íà ïðîáëåìè
ñòèëþ æèòòÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³
òà ïîâèíí³ äîòðèìóâàòèñÿ çàãàëüíî¿ ïðîôåñ³éíî¿
ïîâåä³íêè â åòè÷íèõ ïèòàííÿõ ó ðåàá³ë³òàö³éíèõ
äîñë³äæåííÿõ.
ϳäõ³ä ç ïðàâ ëþäèíè
Áóëà ïîì³òíà çì³íà ìîæëèâîñòåé äëÿ ïðàâ ëþ-
äèíè òà ïðàâîâî¿ áàçè, ùî ñòîñóºòüñÿ äèñêðèì³íàö³¿
îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³. Íà ñüîãîäí³
ó âñüîìó ñâ³ò³ ïîíàä ì³ëüÿðä îñ³á ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³19, ³ âîíè ñêëàäàþòü çíà÷íó ÷àñòè-
íó ñóñï³ëüñòâà. Öå äîð³âíþº ïðèáëèçíî 106 ì³ëüéî-
íàì ëþäåé, ùî æèâóòü â ªâðîï³. Òàêèì ÷èíîì, ¿õí³
ïðàâà º îñíîâíèì íàïðÿìîì ³ âîíè íå º ôðàêö³ºþ,
ÿêó ñë³ä çàäîâîëüíÿòè.  ìèíóëîìó âîíè ïðîñòî
ââàæàëèñÿ ãðóïîþ, ÿê³é ñë³ä íàäàâàòè äîïîìîãó,
àëå ñüîãîäí³ â ªâðîï³ öå º íîðìîþ (àáî ìຠáóòè
òàê), ùî âîíè æèâóòü, ÿê ãðîìàäÿíè ç ïîâíîþ àâ-
òîíî쳺þ, ³íêëþ糺þ, ã³äí³ñòþ òà ïðàâàìè ëþäè-
íè20. Öå º ôóíäàìåíòàëüíèì åëåìåíòîì ó òåêñò³
Êîíâåíö³¿ ïðî ïðàâà îñ³á ç îáìåæåííÿìè æèòòº-
ä³ÿëüíîñò³ ÎÎÍ. Öå òàêîæ ï³äòðèìóºòüñÿ â
Ñòàíäàðò³ ÎÎÍ ç Ïðàâ ëþäèíè, ùî º îñíîâîþ
çàêîíîäàâñòâà, ñïðÿìîâàíîãî íà çàïîá³ãàííÿ äèñ-
êðèì³íàö³¿ ëþäåé ç ïðè÷èí îáìåæåíü æèòòºä³ÿëü-
íîñò³. Êîíâåíö³ÿ ïðî ïðàâà ëþäèíè21 ãîâîðèòü, ùî
îñîáà ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ íå ïîâèí-
íà áóòè ïðåäìåòîì äîãëÿäó (“ïàö³ºíòîì”) ïðîòÿ-
ãîì óñüîãî æèòòÿ. Çàì³ñòü öüîãî â³í àáî âîíà º
ãðîìàäÿíèíîì ç îñîáëèâèìè ïîòðåáàìè, ïîâ’ÿçà-
íèìè ç³ ñïåöèô³÷íèì îáìåæåííÿì æèòòºä³ÿëü-
íîñò³. Ö³ ïîòðåáè ïîâèíí³ çàáåçïå÷óâàòèñÿ ñóñ-
ï³ëüñòâîì, àëå â “íîðìàëüíîìó” êîíòåêñò³. Ó÷àñòü
º ôóíäàìåíòàëüíîþ ³ öåíòðàëüíèì àñïåêòîì öüî-
ãî º äîñòóïí³ñòü äî ñóñï³ëüñòâà. Öå âêëþ÷àº
ô³çè÷íó äîñòóïí³ñòü, íàïð. â ãðîìàäñüê³ ³ ïðèâàòí³
çîíè òà áóä³âë³, à òàêîæ äî ãðîìàäñüêîãî òðàíñ-
ïîðòó, ³íôîðìàö³¿ òîùî. Ó ðÿä³ ºâðîïåéñüêèõ êðà¿í
âñòàíîâëåíî ïðàâèëà ùîäî äîñòóïíîñò³ äëÿ áóä³-
âíèöòâà ãðîìàäñüêèõ áóä³âåëü. Ãåíåðàëüíà Àñàì-
áëåÿ ÎÎÍ ñõâàëèëà ðîçðîáêó Ñòàíäàðò³â ÎÎÍ ó
ãðóäí³ 1993 ðîêó, ³, øëÿõîì ¿¿ ðîçðîáêè â Êîíâåí-
ö³þ ïðî çàáåçïå÷åííÿ îñîáàì ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ ïîâíî¿ ó÷àñò³ òà ð³âíîñò³, òà öå
âàæëèâî äëÿ âñòàíîâëåííÿ ôóíäàìåíòàëüíèõ ïðèí-
öèï³â. ÂÎÎÇ âèçíà÷ຠîáìåæåííÿ æèòòºä³ÿëüíîñò³,
ÿê âçàºìîä³þ îñîáè ç³ ñòàíîì çäîðîâ’ÿ òà ñåðåäî-
âèùà, ùî âèð³øóº áóäü-ÿêó äèñêóñ³þ ì³æ ìåäè÷-
íèì àáî ñîö³àëüíèì ï³äõîäîì äî öüîãî, à òàêîæ ³
ñàì ï³äõ³ä19.
Ðàäà ªâðîïè òàêîæ îïóáë³êóâàëà ñåð³þ äîïîâ³-
äåé òà äîêóìåíò³â ç ïðàâ ëþäèíè äëÿ îñ³á ç îáìå-
æåííÿìè æèòòºä³ÿëüíîñò³. Òóò âîíè íå áóëè äîê-
52 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ëàäíî îïèñàí³, îñê³ëüêè âîíè áóëè îïóáë³êîâàí³ ó
äðóãîìó âèäàíí³ Á³ëî¿ Êíèãè22,23. ¯õ çàâäàííÿì º:
– ïîêðàùèòè ÿê³ñòü æèòòÿ îñ³á ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ òà ¿õ ñ³ìåé ïðîòÿãîì íàñòóï-
íîãî äåñÿòèë³òòÿ;
– ïðèéíÿòè çàõîäè, ùî ñïðÿìîâàí³ íà ï³äâèùåí-
íÿ ÿêîñò³ æèòòÿ îñ³á ç îáìåæåííÿìè æèòòºä³-
ÿëüíîñò³, ÿê³ ïîâèíí³ áàçóâàòèñÿ íà îá´ðóíòî-
âàí³é îö³íö³ ¿õ ñòàíîâèùà, ïîòåíö³àëó òà ïîòðåá;
– ðîçðîáèòè ïëàí ä³é äëÿ äîñÿãíåííÿ öèõ ö³ëåé;
– çàáåçïå÷èòè ð³âí³ñòü äîñòóïó äî ïðàöåâëàøòó-
âàííÿ, ÿê êëþ÷îâîãî åëåìåíòà ñîö³àëüíî¿
ó÷àñò³;
– ïðèéíÿòè ³ííîâàö³éí³ ï³äõîäè, îñê³ëüêè ëþäè ç
ô³çè÷íèìè, ïñèõîëîã³÷íèìè òà ³íòåëåêòóàëüíè-
ìè ïîðóøåííÿìè æèâóòü äîâøå;
– ñòâîðþâàòè çàõîäè äëÿ çàáåçïå÷åííÿ íàëåæíî-
ãî ñòàíó ô³çè÷íîãî òà ïñèõ³÷íîãî çäîðîâ’ÿ íà
ï³çí³õ åòàïàõ æèòòÿ;
– çì³öíþâàòè ï³äòðèìóþ÷³ ñòðóêòóðè íàâêîëî
îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³, ÿê³ ïîòðå-
áóþòü øèðîêî¿ ï³äòðèìêè;
– ñïðèÿòè çàáåçïå÷åííþ ÿêîñò³ ïîñëóã;
– ðîçðîáëÿòè ïðîãðàìè òà ðåñóðñè äëÿ çàäîâî-
ëåííÿ ïîòðåá îñ³á ç îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³.
Çàêîíîäàâñòâî ïðî ïðàâà îñ³á ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ òàêîæ áóëî ñòâîðåíî â ê³ëüêîõ
ºâðîïåéñüêèõ êðà¿íàõ24. Äåÿê³ ç íèõ ìàëè áàãàòî-
ð³÷íå çàêîíîäàâñòâî ç çàãàëüíîþ ïîë³òèêîþ ùîäî
ðåàá³ë³òàö³¿ ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³
(íàïð. Ôðàíö³¿ îòðèìàëà Disabled Persons Act ç
1975), àëå á³ëüø³ñòü êðà¿í ïðèéíÿëè àíòèäèñêðèì³-
íàö³éíå çàêîíîäàâñòâî ëèøå ïðîòÿãîì îñòàíí³õ
ï’ÿòíàäöÿòè-äâàäöÿòè ðîê³â, íàïð.Act of Equal
Opportunities for Disabled Persons (Àêò ïðî ð³âí³
ìîæëèâîñò³ äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³, ͳìå÷÷èíà), Framework Law (Ðàìêîâèé çà-
êîí, ²òàë³ÿ), Constitution Act (Êîíñòèòóö³éíèé Àêò,
Ô³íëÿíä³ÿ), Acton Provision of Rights of Persons with
Disabilities (Àêò ïðî çàáåçïå÷åííÿ ïðàâ îñ³á ç îá-
ìåæåííÿìè æèòòºä³ÿëüíîñò³, Óãîðùèíà, 1998),
Health for All 2004 (Çäîðîâ’ÿ äëÿ âñ³õ 2004, Ñëî-
âåí³ÿ), Disability Discrimination Act 1996 (Àêò ïðî
äèñêðèì³íàö³þ ïðè îáìåæåííÿõ æèòòºä³ÿëüíîñò³
1996, Âåëèêà Áðèòàí³ÿ), Toward Inclusion 2001 (Äî
³íêëþ糿 2001, Âåëèêà Áðèòàí³ÿ) òà ³í.
Öå íàñòóïí³7:
– Ðåàá³ë³òàö³ÿ òà ïðàâî íà çäîðîâ’ÿ îïèñàíà ó
Âñåñâ³òí³é äîïîâ³ä³ ç îáìåæåíü æèòòºä³ÿëüíîñò³
(2011) òà Êîíâåíö³¿ ÎÎÍ ïðî ïðàâà ëþäèíè
(2005) 19,25,26. Ïðàâà ëþäèíè ´ðóíòóþòüñÿ íà
ö³ííîñòÿõ FREDA (Freedom, Respect, Equality,
Dignity, Autonomy – Ñâîáîäà, Ïîâàãà, гâí³ñòü,
óäí³ñòü, Àâòîíîì³ÿ), ùî äຠñâîáîäó â³ä äèñ-
¹2(2) *2018
 ÐÎÇÄ²Ë 2 – ×ÎÌÓ ÐÅÀÁ²Ë²ÒÀÖ²ß ÏÎÒвÁÍÀ ²ÍÄȲÄÓÓÌÓ ÒÀ ÑÓÑϲËÜÑÒÂÓ
êðèì³íàö³¿, îñîáëèâî âðàõîâóþ÷è ïðàâà ìåí-
øèí. Âñ³ ÷ëåíè ñóñï³ëüñòâà ìàþòü ïðàâî íà
çäîðîâ’ÿ ç òî÷êè çîðó äåòåðì³íàíò çäîðîâ’ÿ,
ñàí³òàð³¿, ¿æ³, âîäè, õàð÷óâàííÿ òà ïðàâà íà ðåà-
á³ë³òàö³þ. Êîíöåïòóàëüíèé îïèñ ðåàá³ë³òàö³¿
ðàí³øå áóâ îïèñàíèé â êîíòåêñò³ éîãî íàäàííÿ
÷åðåç ñåêòîð îõîðîíè çäîðîâ’ÿ.
– Ðåàá³ë³òàö³ÿ òàêîæ ï³äòðèìóºòüñÿ ì³æíàðîäíèì
ïðàâîì, ³ áàãàòî íàïèñàíî â áàãàòüîõ äåêëàðà-
ö³ÿõ òà êîíâåíö³ÿõ – íàïð. 2006 Êîíâåíö³ÿ ÎÎÍ
ïðî ïðàâà îñ³á ç îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³27. Îäíàêîâî, ðåàá³ë³òàö³ÿ ï³äòðèìóºòüñÿ
ðåã³îíàëüíèì çàêîíîäàâñòâîì ªÑ, ³ öå îïèñóº
ªâðîïåéñüêà êîíâåíö³ÿ ç ïðàâ ëþäèíè. Íàðåøò³,
ÔÐÌ òà ïîñëóãè îõîðîíè çäîðîâ’ÿ ï³äòðèìóþòü
ïðàâîçàõèñíèé ï³äõ³ä äî ïðàêòèêè ðåàá³ë³òàö³¿ òà
ïîñëóã ÔÐÌ. Âîíè ïîâèíí³ áóòè íàÿâíèìè, ïðèé-
íÿòíèìè äëÿ êîðèñòóâà÷³â, áóòè âèñîêîÿê³ñíè-
ìè òà äîñòóïíèìè äëÿ âñ³õ (òîáòî íå äèñêðèì³-
íàö³éíèìè, ô³çè÷íèìè òà äîñòóïíèìè çà ö³íîþ,
â ìåæàõ åòè÷íî¿ ñôåðè), àëå öå íå çàêð³ïëåíî
çàêîíîì ÷è êîíâåíö³ÿìè.
– Âîíè òàêîæ ïîâèíí³ çàêð³ïëþâàòè ïðîôåñ³éí³
ö³ííîñò³ òà ñòàíäàðòè, ìåäè÷íó îñâ³òó òà íà-
â÷àííÿ ç ïèòàíü åòèêè, ïðàâ ëþäèíè òà àäâî-
êàö³¿.
Ðåêîìåíäàö³¿ ìàëè27:
– ñïðèÿòè ïðîôåñ³éíèì ñòàíäàðòàì;
– âèñóâàòè íà ïåðåäí³é ïëàí îñâ³òó òà íàâ÷àííÿ ç
ïèòàíü åòèêè òà ïðàâ ëþäèíè äëÿ ìåäè÷íèõ
ñòóäåíò³â òà ë³êàð³â, ùî íàâ÷àþòüñÿ;
– çàîõî÷óâàòè îñâ³òó ñåðåä ëþäåé ç îáìåæåííÿ-
ìè æèòòºä³ÿëüíîñò³, âïëèâàòè íà ïîë³òèê³â òà
äîïîìàãàòè àäâîêàö³¿.
Ç òî÷êè çîðó ïðàâ ëþäèíè ðåàá³ë³òàö³éíà ïðàê-
òèêà íàêëàäຠîñíîâí³ ñòàíäàðòè íàäàííÿ ïîñëóã
îõîðîíè çäîðîâ’ÿ, ÿê³ ïîâèíí³ áóòè:
– äîñòóïí³ ç ô³çè÷íî¿ òà ³íôîðìàö³éíî¿ òî÷êè çîðó;
– íå äèñêðèì³íàö³éíèìè;
– äîñòóïíèìè çà ö³íîþ;
– ïðèéíÿòíèìè ç åòè÷íî¿ òà êóëüòóðíî¿ òî÷êè çîðó;
– íàóêîâî òà ìåäè÷íî äîö³ëüíèìè òà íàéâèùî¿
ÿêîñò³.
Ïîâåðòàþ÷èñü äî îõîðîíè çäîðîâ’ÿ, ïåðâèííîþ
ìåòîþ ïîë³òèêè îõîðîíè çäîðîâ’ÿ º ìàêñèì³çàö³ÿ
çäîðîâ’ÿ íàñåëåííÿ â ìåæàõ íàÿâíèõ ðåñóðñ³â òà
åòè÷íèõ ðàìîê, çàñíîâàíà íà ïðèíöèïàõ ñïðàâåä-
ëèâîñò³ òà ñîë³äàðíîñò³. ²ííîâàö³éí³ òåõíîëî㳿, ùî
íàäàþòü òåðàïåâòè÷íó âèãîäó, ïîâèíí³ áóòè äîñ-
òóïíèìè çà ïðèéíÿòíîþ ö³íîþ28. Âàð³àíòè, ùî ìà-
þòüñÿ íà óâàç³, íà ìàêðî-, ìåçî- òà ì³êðîð³âí³ áó-
äóòü îïèñàí³ íèæ÷å.  2005 ðîö³ Âñåñâ³òíÿ
àñàìáëåÿ îõîðîíè çäîðîâ’ÿ ïðèéíÿëà Ðåçîëþö³þ
“Îáìåæåííÿ æèòòºä³ÿëüíîñò³, âêëþ÷àþ÷è ïðåâåí-
ö³þ, óïðàâë³ííÿ òà ðåàá³ë³òàö³þ”, ³ çðîáèëà íèçêó
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ðåêîìåíäàö³é, ÿê³ íàäàëè Ãåíåðàëüíîìó äèðåêòî-
ðó ðÿä çàâäàíü 29 . ÂÎÎÇ ðîçãëÿäຠîáìåæåííÿ
æèòòºä³ÿëüíîñò³, ÿê ïðîáëåìó ïðàâ ëþäèíè, ïðî-
áëåìó ãðîìàäñüêîãî çäîðîâ’ÿ òà ïðîáëåìó ðîçâèò-
êó 30,31 .
Çàñòîñóâàííÿ ïðèíöèï³â (ìåäè÷íî¿) åòèêè
Ç òî÷êè çîðó ìåäè÷íî¿ åòèêè, ùî öå îçíà÷ຠäëÿ
ìåäè÷íî¿ ïðàêòèêè? Ñï³ëüíå ïðèéíÿòòÿ ð³øåíü
âàæëèâå äëÿ ë³êàð³â-êë³í³öèñò³â ó âñ³õ ìåäè÷íèõ
ñïåö³àëüíîñòÿõ, àëå îñîáëèâî äëÿ ë³êàð³â ÔÐÌ.
Ïðèéíÿòòÿ ïðàâ ëþäèíè, ÿê ðóø³éíî¿ ñèëè äëÿ
³íêëþçèâíî¿ ïîë³òèêè òà ìåäè÷íî¿ åòèêè º íàð³æíèì
ïðèíöèïîì ïàö³ºíò-öåíòðè÷íî¿ ðåàá³ë³òàö³éíî¿ äî-
ïîìîãè òà ïðàêòèêè ÔÐÌ. Çàõèñò ó ïðèéíÿòò³
ð³øåíü íà ð³âíÿõ óðÿäó òà ïëàíóâàííÿ. Öåé ðîçä³ë
ðîçãëÿäຠëèøå åòè÷í³ ïðèíöèïè íà ìàêðîð³âí³,
òîáòî ó çâ’ÿçêó ç ïîë³òèêîþ îõîðîíè çäîðîâ’ÿ.
Êîíöåïòóàëüí³ âèáîðè, çðîáëåí³ ñóñï³ëüñòâîì òà
îðãàíàìè îõîðîíè çäîðîâ’ÿ, ìîæóòü âïëèâàòè íà
ð³øåííÿ ñòîñîâíî ëþäåé ç îáìåæåííÿìè æèòòºä³-
ÿëüíîñò³. Öå âêëþ÷ຠêîíöåïö³¿ îáìåæåííÿ æèòòº-
ä³ÿëüíîñò³ òà â³äïîâ³ä³, ùî îïèñàí³ âèùå. Âñåñâ³òíÿ
äîïîâ³äü ç îáìåæåíü æèòòºä³ÿëüíîñò³ (2011) òà
Êîíâåíö³ÿ ÎÎÍ ïðî ïðàâà îñ³á ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ (UNCRPD, 2006) ï³äêðåñëèëè
âàæëèâ³ñòü àäâîêàö³¿ äëÿ îñ³á ç îáìåæåííÿìè æèò-
òºä³ÿëüíîñò³ çà äîïîìîãîþ Ãëîáàëüíîãî ïëàíó ä³é
ÂÎÎÇ ç îáìåæåíü æèòòºä³ÿëüíîñò³ íà 2014-2021
ðîêè ”Êðàùå çäîðîâ’ÿ äëÿ âñ³õ ëþäåé ç îáìåæåí-
íÿìè æèòòºä³ÿëüíîñò³”18,27,30. Ñòàòòÿ 1 UNCRPD
îïèñóº ìåòó Êîíâåíö³¿: çàîõî÷åííÿ, çàõèñò é çàáåç-
ïå÷åííÿ ïîâíîãî é ð³âíîãî çä³éñíåííÿ âñ³ìà îñîáà-
ìè ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ âñ³õ ïðàâ ëþ-
äèíè é îñíîâîïîëîæíèõ ñâîáîä, à òàêîæ ó
çàîõî÷åíí³ ïîâàæàííÿ ïðèòàìàííîãî ¿ì äîñòî¿í-
ñòâà. UNCRPD º þðèäè÷íî îáîâ’ÿçêîâîþ ó êðà¿-
íàõ, ÿê³ ¿¿ ðàòèô³êóâàëè, à ñòàòòÿ 26 “Àá³ë³òàö³ÿ òà
ðåàá³ë³òàö³ÿ” çàêëèêຠäåðæàâè îðãàí³çîâóâàòè,
çì³öíþâàòè òà ðîçøèðþâàòè êîìïëåêñí³ àá³ë³-
òàö³éí³ òà ðåàá³ë³òàö³éí³ ïîñëóãè é ïðîãðàìè, îñîá-
ëèâî ó ñôåð³ îõîðîíè çäîðîâ’ÿ, çàéíÿòîñò³, îñâ³òè
é ñîö³àëüíîãî îáñëóãîâóâàííÿ.
Âñå öå çàêð³ïëåíî â ïðàêòèö³ ÔÐÌ ³ ï³äòðè-
ìóºòüñÿ ë³êàðÿìè ÔÐÌ, òîìó ðåàá³ë³òàö³ÿ ñòàëà
êëþ÷îâîþ ñòðàòå㳺þ îõîðîíè çäîðîâ’ÿ XXI ñòî-
ë³òòÿ32. Öå ìຠâðàõîâóâàòè çðîñòàþ÷ó ïîòðåáó â
ðåàá³ë³òàö³¿ âíàñë³äîê äîñÿãíåíü â îõîðîí³ çäîðî-
â’ÿ òà ìåäè÷íèõ òåõíîëîã³ÿõ, ñòàð³ííÿ íàñåëåííÿ,
çá³ëüøåííÿ âèæèâàííÿ òà î÷³êóâàíî¿ òðèâàëîñò³
æèòòÿ, à òàêîæ çá³ëüøåííÿ òÿãàðÿ õðîí³÷íèõ òà
äîâãîòðèâàëèõ ñòàí³â, ùî ñòâîðþº òèñê íà äîäàò-
êîâ³ âèòðàòè íà òë³ ñêîðî÷åíü áþäæåò³â.
Åòè÷í³ òà êóëüòóðí³ àñïåêòè òàêîæ îáãîâîðþ-
þòüñÿ â ³íøèõ ðîçä³ëàõ êíèãè òà äåìîíñòðóþòü, ùî
53
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ë³êàð³ ÔÐÌ òàêîæ âèñòóïàþòü â ðîë³ àäâîêàò³â ó
êîíñóëüòóâàíí³ óðÿä³â òà îðãàí³çàòîð³â îõîðîíè
çäîðîâ’ÿ ùîäî ïðèéíÿòòÿ ð³øåíü. Ö³ ðîçä³ëè ïîêà-
æóòü, ùî âîíè òàêîæ ðîçãëÿäàþòüñÿ â íàâ÷àëüíèõ
ïðîãðàìàõ ç ðåàá³ë³òàö³¿ òà ï³ñëÿäèïëîìíîãî íà-
â÷àííÿ. Ïðîôåñ³îíàëè, ÿê³ íàäàþòü ïîñëóãè ÔÐÌ,
ïîâèíí³ ìàòè ÷àñ (³ ðîáèòè), ùîá çàäóìàòèñÿ íàä
öèìè ïèòàííÿìè.
Ðåàá³ë³òàö³ÿ òà ñèñòåìè îõîðîíè çäîðîâ’ÿ
Äîñòóï äî òà ô³íàíñóâàííÿ ðåàá³ë³òàö³éíèõ ïî-
ñëóã âàð³þþòü çàëåæíî â³ä êðà¿íè, ³ áàãàòî ç öèõ
âàð³àíò³â çàëåæàòü â³ä â³äïîâ³äíèõ ñèñòåì îõîðî-
íè çäîðîâ’ÿ òà ñîö³àëüíèõ ñèñòåì33,34. ³äì³ííîñò³
òàêîæ âèÿâëÿþòüñÿ ÷åðåç â³äì³ííîñò³ ó ñïîñîá³
çáèðàííÿ òà îáðàõóíêó äàíèõ. Ó äåÿêèõ êðà¿íàõ
ìîæóòü áóòè íàâ³òü ðåã³îíàëüí³ â³äì³ííîñò³. Çàö³-
êàâëåí³ ñòîðîíè âêëþ÷àþòü îðãàíè îõîðîíè çäî-
ðîâ’ÿ (ïîë³òèêè, à òàêîæ àäì³í³ñòðàòîðè), îðãàí³-
çàö³¿ ãðîìàäñüêîãî çäîðîâ’ÿ, ïëàòíèêè
(ñòðàõóâàííÿ â îõîðîí³ çäîðîâ’ÿ òà ñîö³àëüíå ñòðà-
õóâàííÿ, àáî ³íø³ îðãàí³çàö³¿, ÿê³ ô³íàíñóþòü îõî-
ðîíó çäîðîâ’ÿ òà ñîö³àëüíó äîïîìîãó), íàäàâà÷³
ïîñëóã, ïðîôåñ³îíàëè îõîðîíè çäîðîâ’ÿ, ñïîæèâà÷³
òà ãðîìàäà.
Äîñòóï äî ðåàá³ë³òàö³éíèõ âòðó÷àíü êåðóºòüñÿ
ïðèçíà÷åííÿì â³ä ë³êàðÿ ÔÐÌ. Îáãîâîðåííÿ ðåà-
á³ë³òàö³¿ ïî âñ³é ªâðîï³ ìຠâ³äîêðåìèòè âèñîêîñ-
ïåö³àë³çîâàí³ âòðó÷àííÿ, òàê³ ÿê ò³, ùî íàäàþòüñÿ
ë³êàðåì ÔÐÌ â³ä ñïåö³àë³çîâàíèõ âòðó÷àíü, òàê³ ÿê
ë³êóâàííÿ ïðîëåæí³â òà çàãàëüí³ âòðó÷àííÿ, òàê³ ÿê
âòðó÷àííÿ ç ìîá³ë³çàö³¿ ï³ñëÿ, ñêàæ³ìî, íåóñêëàä-
íåíîãî ïåðåëîìó ê³íö³âîê. Öåé ðîçä³ë íå çìîæå
âèð³øèòè âñ³ ö³ ïèòàííÿ, îñê³ëüêè âîíè îïëà÷óþòüñÿ
ïî-ð³çíîìó, àëå âñ³ âîíè íàäàþòüñÿ òèì ÷è ³íøèì
÷èíîì. Ïëàòíèêè òà óïîâíîâàæåí³ ç îõîðîíè çäî-
ðîâ’ÿ ïîâèíí³ çíàòè ïðî ö³íí³ñòü ñïåö³àë³çîâàíèõ
âòðó÷àíü, ÿê³ ïîòðåáóþòü ìóëüòè-ïðîôåñ³éíî¿ êî-
ìàíäè, íà â³äì³íó â³ä îäíîãî ïðàêòèêóþ÷îãî ñïåö³-
àë³ñòà. Âîíè ìîæóòü çäàâàòèñÿ êîøòîâíèìè, îä-
íàê ³ñíóþòü ãàðí³ äîêàçè ¿õ ðåíòàáåëüíîñò³ â
ãîñòðèõ, ï³äãîñòðèõ òà äîâãîòðèâàëèõ çàêëà-
äàõ35,36. ÔÐÌ ïðèñóòíÿ â óñ³õ, êð³ì îäíîãî ç 34
÷ëåí³â ªÑÌÑ, ³ êîæíà êðà¿íà ìຠâèçíà÷àòè, ùî
áóäå àáî íå áóäå ô³íàíñóâàòèñÿ ÷åðåç çâè÷àéí³
ïîòîêè ðåñóðñ³â.
Öÿ êíèãà ñòîñóºòüñÿ ïåðø çà âñå ÔÐÌ ó
á³ëüøîñò³ ºâðîïåéñüêèõ êðà¿í. Âòðó÷àííÿ ÔÐÌ
ïîêðèâàþòüñÿ ïàêåòîì ãðîìàäñüêîãî ñòðàõóâàí-
íÿ, îñîáëèâî äëÿ ñïåö³àë³çîâàíî¿ ðåàá³ë³òàö³¿ ó ãî-
ñòðèõ çàêëàäàõ, ³ Ðîçä³ë 8 îïèñóº ð³çí³ åòàïè ïðî-
öåñó ÔÐÌ. Ïðîòå ïðàêòè÷íî ñêð³çü ³ñíóº
äîïîâíåííÿ “ç êèøåí³” äëÿ ïàö³ºíòà, ÿêå çàçâè÷àé
º íàéá³ëüøèì ïðîòÿãîì õðîí³÷íî¿ òà äîâãîòðèâà-
54 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ëî¿ äîïîìîãè. ×àñòî ïðèâàòí³ ñòðàõîâ³ ñèñòåìè òà
ïðèâàòí³ ë³êàðí³ ³ñíóþòü äëÿ ïàö³ºíò³â, ÿê³ õî÷óòü
çàâåðøèòè ë³êóâàííÿ ç äîäàòêîâîþ äîïîìîãîþ
á³ëüø í³æ íàäຠãðîìàäñüêèé ïàêåò. ϳäãîñòð³
ïðîãðàìè ÔÐÌ òà ô³çè÷íà òåðàï³ÿ ìîæóòü áóòè
îáìåæåíèìè çà òðèâàë³ñòþ àáî ê³ëüê³ñòþ ñåàíñ³â,
àëå íàéá³ëüøà âàð³àáåëüí³ñòü ³ñíóº ïðè äîâãîòðè-
âàë³é ðåàá³ë³òàö³¿. Çäàºòüñÿ, öå ïîõîäèòü â³ä ³ñòî-
ðè÷íèõ â³äì³ííîñòåé, ãîëîâíèì ÷èíîì ì³æ ïîïå-
ðåäíüîþ Ñõ³äíîþ òà Çàõ³äíîþ ªâðîïîþ, à òàêîæ
ì³æ ï³âí³÷íèìè òà ñåðåäçåìíîìîðñüêèìè ðàéîíà-
ìè. Ó äåÿêèõ êðà¿íàõ íåìຠäåðæàâíîãî ô³íàíñó-
âàííÿ äëÿ äîâãîòðèâàëî¿ äîïîìîãè, òèì á³ëüøå ç
÷àñó íåùîäàâíüî¿ ô³íàíñîâî¿ êðèçè. Ó á³ëüøîñò³
êðà¿í Öåíòðàëüíî¿ òà Ñõ³äíî¿ ªâðîïè äîâãîòðèâà-
ëà ðåàá³ë³òàö³ÿ çàçâè÷àé äîñèòü äîáðå îðãàí³çîâà-
íà ³ ìîæå áóòè îá’ºäíàíà ç³ “Ñïà-öåíòðàìè”.
Ïîñëóãè ÔÐÌ â ãîñòðîìó ïåð³îä³ (ñòàö³îíàðí³
òà àìáóëàòîðí³) çàçâè÷àé âáóäîâàí³ äî ãîñòðèõ /
çàãàëüíèõ ë³êàðåíü àáî äî ïðèâàòíî¿ ïðàêòèêè (àì-
áóëàòîðí³). ϳäãîñòð³ ïîñëóãè íàäàþòüñÿ â ö³ëîìó,
à òàêîæ ó ñïåö³àë³çîâàíèõ ë³êàðíÿõ / öåíòðàõ, òîä³
ÿê äîâãîòðèâàë³ ïîñëóãè ïåðåâàæíî îðãàí³çîâóþòü-
ñÿ â ñïåö³àë³çîâàíèõ çàêëàäàõ, ³íîä³ çàëåæíî â³ä
ñîö³àëüíîãî îáñëóãîâóâàííÿ, í³æ îõîðîíè çäîðîâ’ÿ.
Ó äåÿêèõ êðà¿íàõ ïàö³ºíòè ìàþòü äîñòóï äî
ïðîãðàì ÔÐÌ ÷åðåç íàïðàâëåííÿ äî ë³êàðÿ ÔÐÌ,
îäíàê ³ñíóº òåíäåíö³ÿ íàïðàâëåííÿ ïàö³ºíò³â ç ãî-
ñòðèõ ïîñëóã äëÿ ïî÷àòêó ðàííüî¿ ðåàá³ë³òàö³¿ ï³ä
íàãëÿäîì ë³êàð³â ÔÐÌ.
Íåçâàæàþ÷è íà òå, ùî ÔÐÌ âèçíàºòüñÿ ìàé-
æå ó êîæí³é êðà¿í³ ªâðîïè, ðîçïîä³ë ôàõ³âö³â çàëè-
øàºòüñÿ â³äíîñíî íèçüêèì. ²ñíóº âåëèêà ð³çíèöÿ â
ê³ëüêîñò³ ôàõ³âö³â ïî êðà¿íàõ, ¿õ ðîë³ â ñèñòåì³ îõî-
ðîíè çäîðîâ’ÿ òà â ¿õí³õ óìîâàõ ðîáîòè. Òàáëèöÿ 1
Ðîçä³ëó 5 ïîêàçóº ð³çíèöþ â ê³ëüêîñò³ ôàõ³âö³â ïî
êðà¿íàõ, ³, õî÷à îïòèìàëüíà ê³ëüê³ñòü ë³êàð³â ÔÐÌ
íà îäèíèöþ íàñåëåííÿ ùå íå º âèçíà÷åíîþ äëÿ âñ³º¿
ªâðîïè, ³ñíóº î÷åâèäíà íåâ³äïîâ³äí³ñòü ì³æ êðà¿-
íàìè.
Åêîíîì³÷íèé òÿãàð îáìåæåíü
æèòòºä³ÿëüíîñò³
Âàðò³ñòü îáìåæåíü æèòòºä³ÿëüíîñò³
Åêîíîì³÷íèé òÿãàð îáìåæåíü æèòòºä³ÿëüíîñò³
íàáóâຠá³ëüøî¿ âàæëèâîñò³, çâàæàþ÷è íà
çá³ëüøåííÿ ê³ëüêîñò³ îñ³á ç îáìåæåííÿìè æèòòº-
ä³ÿëüíîñò³ òà âïëèâó á³ëüøîãî ³ äîâøîãî âèæèâàí-
íÿ. Êð³ì òîãî, åêîíîì³÷íà êðèçà â ªâðîï³ ñòàâèòü
ïèòàííÿ ïðî òå, ÿê ö³ ëþäè áóäóòü ï³äòðèìóâàòè-
ñÿ çà äîïîìîãîþ åêîíîì³÷íî¿ ï³äòðèìêè. Çðîñòàí-
íÿ öèõ ïîêàçíèê³â âæå ôîðìóº åêîíîì³÷íå òà
ñîö³àëüíå íàâàíòàæåííÿ íà ñóñï³ëüñòâî, ³ âîíî,
¹2(2) *2018
 ÐÎÇÄ²Ë 2 – ×ÎÌÓ ÐÅÀÁ²Ë²ÒÀÖ²ß ÏÎÒвÁÍÀ ²ÍÄȲÄÓÓÌÓ ÒÀ ÑÓÑϲËÜÑÒÂÓ

éìîâ³ðíî, ïîã³ðøóâàòèìåòüñÿ, îñê³ëüêè â³ê ä³òåé, íî â 2,5 ðàçè ïåðåâèùóº âèòðàòè íà äîïîìîãó ïî
ùî íàðîäèëèñÿ ï³ñëÿ Äðóãî¿ Ñâ³òîâî¿ Â³éíè ï³ä ÷àñ áåçðîá³òòþ òà ñòàíîâèòü áëèçüêî 5% ÂÂÏ ó ͳäåð-
áóìó íàðîäæóâàíîñò³, ìèíຠ70 ðîê³â. Ñïðàâæíþ ëàíäàõ òà Íîðâå㳿40. Îö³íêà âòðàò ïðîäóêòèâíîñò³
ê³ëüê³ñòü ëþäåé ç âàæêèìè òà ïîì³ðíî âàæêèìè âíàñë³äîê îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà â³äïîâ³-
îáìåæåííÿìè æèòòºä³ÿëüíîñò³ âàæêî âèçíà÷èòè, äíèõ ïîäàòê³â, òàêèì ÷èíîì, ñêëàäíà òà ïîòðåáóº
àëå âîíè, áåçóìîâíî, ñòàâëÿòü âèìîãè äî ñèñòåìè ñòàòèñòè÷íî¿ ³íôîðìàö³¿.
îõîðîíè çäîðîâ’ÿ. Îäíà ç ïðè÷èí ïîëÿãຠâ òîìó, Íåäàâí³ì äîñë³äæåííÿì çàïðîïîíîâàíî, ùî
ùî âèçíà÷åííÿ îáìåæåíü æèòòºä³ÿëüíîñò³ ÷àñòî âàðò³ñòü îáìåæåíü æèòòºä³ÿëüíîñò³ ïîâ’ÿçàíà ç
çì³íþºòüñÿ â ð³çíèõ äèñöèïë³íàõ. ²ñíóþòü òàêîæ äâîìà ïðîáëåìàìè41. Ïåðøà – ô³íàíñîâà. Îñîáàì
ð³çí³ ³íñòðóìåíòè îö³íþâàííÿ òà ð³çí³ äåðæàâí³ ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ á³ëüø ñêëàäíî
ïðîãðàìè äëÿ îáìåæåíü æèòòºä³ÿëüíîñò³, ùî ïðè- çíàéòè ðîáîòó, çáåðåãòè ïðàöåâëàøòóâàííÿ àáî
çâîäèòü äî òðóäíîù³â ïðè ïîð³âíÿíí³ äàíèõ ç ð³çíèõ âîíè ìîæóòü îòðèìàòè íèæ÷èé äîõ³ä; îäíàê, ¿ì,
äæåðåë33. Äîäàòêîâî, îáìåæåí³ äàí³ ïðî êîìïîíåí- ìîæëèâî, äîâåäåòüñÿ âèêîðèñòîâóâàòè âëàñí³
òè âàðòîñò³ îáìåæåíü æèòòºä³ÿëüíîñò³ óñêëàäíþ- ô³íàíñè / çàîùàäæåííÿ äëÿ äîñÿãíåííÿ çàäîâîëå-
þòü ê³ëüê³ñíó îö³íêó âòðàòè ïðîäóêòèâíîñò³ òà íå íîñò³ àáî, ìîæëèâî, çíàäîáèòüñÿ á³ëüøèé äîõ³ä
³ñíóº çàãàëüíîïðèéíÿòèõ ìåòîä³â îö³íêè âàðòîñò³1. ëèøå çà çâè÷àéíó àêòèâí³ñòü. Äðóãà ïðîáëåìà
Äëÿ ë³ïøîãî ðîçóì³ííÿ, ìè ïîâèíí³ ñêîðèñòàòèñÿ ïîâ’ÿçàíà ç ñèñòåìàìè ñîö³àëüíîãî çàõèñòó, ÿê³ íà-
âèçíà÷åííÿì îáìåæåíü æèòòºä³ÿëüíîñò³ çà ÌÊÔ37, äàþòü ïîñëóãè ÷åðåç ïðÿìå îïîäàòêóâàííÿ àáî
ÿê ôóíêö³îíàëüíîãî îáìåæåííÿ, ÿêå º ðåçóëüòàòîì ñïðèÿòëèâå ñåðåäîâèùå, òàêå, ÿê ïåðåâàãè â ïàð-
íå ò³ëüêè ïîðóøåíü àáî ïåðñîíàëüíèõ îáìåæåíü êîâö³ àáî ñóáñè䳿 íà ïðàöåâëàøòóâàííÿ, ñïðÿìî-
ïîâñÿêäåííî¿ àêòèâíîñò³, àëå é òàêîæ â³ä ñï³ââ³äíî- âàí³ íà êîìïåíñàö³þ á³ëüø âèñîêèõ âèòðàò, ïîâ’ÿ-
øåííÿ îñîáè òà ñåðåäîâèùà, ùî âêëþ÷ຠäèñôóí- çàíèõ ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ ó áàãàòüîõ
êö³þ íà îäíîìó àáî äåê³ëüêîõ ç òðüîõ ð³âí³â: ïîðó- êðà¿íàõ41.
øåííÿ, îáìåæåííÿ àêòèâíîñò³ òà îáìåæåííÿ Ó ªâðîï³ äåÿê³ ïîë³òèêè ñïðÿìîâàí³ íà ðå³íòåã-
ìîæëèâîñò³ ó÷àñò³.  ðåçóëüòàò³ öüîãî âòðàòà ðàö³þ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ äî ðî-
çäàòíîñò³, íà ô³çè÷íîìó ÷è ïñèõ³÷íîìó ð³âíÿõ, çíè- áîòè, ³íø³ ïðàãíóòü êîìïåíñóâàòè îñîáàì ç îáìå-
æóº âèêîíàííÿ äåÿêèõ àêòèâíîñòåé ïîâñÿêäåííî-
ãî æèòòÿ, çá³ëüøóþ÷è âèòðàòè íà äîñÿãíåííÿ ïåâ-
íîãî ð³âíÿ áëàãîïîëó÷÷ÿ. ³äïîâ³äíî äî
Âñåñâ³òíüî¿ äîïîâ³ä³ ç îáìåæåíü æèòòºä³ÿëüíîñò³,
ö³íà îáìåæåíü æèòòºä³ÿëüíîñò³ ìîæå áóòè êëàñè-
ô³êîâàíà ÿê ïðÿìà, òàê ³ íåïðÿìà19 (Ìàëþíîê 1).
Ïðÿì³ âèòðàòè ìîæíà ðîçä³ëèòè íà äâ³ êàòåãîð³¿:
(i) äîäàòêîâ³ âèòðàòè, ç ÿêèìè ñòèêàþòüñÿ îñîáè
ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà ¿õí³ ðîäèíè äëÿ
äîñÿãíåííÿ ïîâñÿêäåííèõ æèòòºâèõ ñòàíäàðò³â òà
(³³) äîïîìîãà ç îáìåæåíü æèòòºä³ÿëüíîñò³, ùî íà-
äàºòüñÿ óðÿäàìè. Ó Ñïîëó÷åíîìó Êîðîë³âñòâ³
îö³íêè ñêëàäàþòü â³ä 11% äî 69% â³ä ñòàíäàðò-
íîãî äîõîäó38. Ó ²ðëàí䳿 ïðèáëèçíà âàðò³ñòü îá-
ìåæåííÿ æèòòºä³ÿëüíîñò³ êîëèâàºòüñÿ â³ä 20,3% äî
37,3% â³ä ñåðåäíüîãî òèæíåâîãî äîõîäó, çàëåæíî
â³ä òðèâàëîñò³ òà ñòóïåíÿ îáìåæåííÿ öèõ ëþäåé.
³í âèùå ó òèõ, õòî ìຠâàæê³ îáìåæåííÿ39. 14%
äëÿ äîìîãîñïîäàðñòâ â Áîñí³¿ òà Ãåðöåãîâèí³ 40
êëàñèô³êóþòüñÿ ÿê òàê³, ùî ìàþòü îñîáó ç îáìå-
æåííÿìè æèòòºä³ÿëüíîñò³.
Äåðæàâí³ âèòðàòè íà ïðîãðàìè ç îáìåæåíü
æèòòºä³ÿëüíîñò³ âêëþ÷àþòü äîïîìîãó ç ïîâíîãî
àáî ÷àñòêîâîãî îáìåæåííÿ æèòòºä³ÿëüíîñò³, à òà-
êîæ ïëàíóâàííÿ ðàííüîãî âèõîäó íà ïåíñ³þ â³äïî-
â³äíî äî ñïåöèô³êè îáìåæåííÿ æèòòºä³ÿëüíîñò³.
Âèòðàòè ñêëàäàþòü áëèçüêî 2% âàëîâîãî âíóòð³-
øíüîãî ïðîäóêòó (ÂÂÏ) âêëþ÷íî ç âèïëàòàìè ïî
ëèñòêàõ òèì÷àñîâî¿ íåïðàöåçäàòíîñò³. Öå ïðèáëèç- Ìàëþíîê 1. Âàðò³ñòü îáìåæåíü æèòòºä³ÿëüíîñò³

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 55
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
æåííÿìè æèòòºä³ÿëüíîñò³. Çà äàíèìè Eurostat,
äåðæàâí³ ñîö³àëüí³ âèòðàòè íà îáìåæåííÿ æèòòº-
ä³ÿëüíîñò³ â ªÑ-28 â 2012 ðîö³ ñÿãíóëè 2% â³ä ÂÂÏ,
ïî÷èíàþ÷è ç 0,7% íà ʳïð³ äî 4,4% ó Äàí³¿41.
ªâðîïåéñüêà êîì³ñ³ÿ âèñâ³òëèëà â ªâðîïåéñüê³é
ñòðàòå㳿 ç îáìåæåíü æèòòºä³ÿëüíîñò³ íà 2010-
2020 ðîêè42 â³ñ³ì íàïðÿìê³â ñï³ëüíèõ ä³é ì³æ ªÑ òà
äåðæàâàìè-÷ëåíàìè ªÑ. Öå:
– äîñòóïí³ñòü;
– ó÷àñòü;
– ð³âí³ñòü;
– ïðàöåâëàøòóâàííÿ;
– îñâ³òà òà íàâ÷àííÿ;
– ñîö³àëüíèé çàõèñò;
– çäîðîâ’ÿ òà çîâí³øí³ ä³¿.
Ðîëü ðåàá³ë³òàö³¿ ó çíèæåíí³ âàðòîñò³
îáìåæåíü æèòòºä³ÿëüíîñò³
Òàêèì ÷èíîì, ðåàá³ë³òàö³ÿ, â ïðèíöèï³, ìຠêëþ-
÷îâó ðîëü ó çíèæåíí³ âàðòîñò³ îáìåæåíü æèòòº-
ä³ÿëüíîñò³ øëÿõîì ñïðèÿííÿ ôóíêö³îíàëüíîìó
â³äíîâëåííþ òà çá³ëüøåííþ ôóíêö³¿ ç ìåíåäæìåí-
òîì ôàêòîð³â ñåðåäîâèùà. Ùîá çìåíøèòè
âàðò³ñòü îáìåæåíü æèòòºä³ÿëüíîñò³, òàêà ã³ïîòå-
çà ïîâèííà ìàòè ãàðíå ñï³ââ³äíîøåííÿ ö³íà-âèòðà-
òè. Îñòàíí³ì ÷àñîì äâà äîñë³äæåííÿ ö³íè-âèòðàò
ñòàö³îíàðíî¿ ðåàá³ë³òàö³¿ – îäíå äëÿ ñêëàäíèõ îá-
ìåæåíü æèòòºä³ÿëüíîñò³ âíàñë³äîê íåâðîëîã³÷íèõ
ðîçëàä³â ó Âåëèê³é Áðèòàí³¿43, à ³íøå – äëÿ ÷åðåï-
íî-ìîçêîâî¿ òðàâìè â ²ðëàí䳿44 – ÷³òêî ïðîäåìîí-
ñòðóâàëè ³ñòîòíó åêîíîì³þ âèòðàò íà ïîòî÷íó äî-
ïîìîãó, îòðèìàíó øëÿõîì ðåàá³ë³òàö³¿ ³ç ñåðåäí³ì
ùîòèæíåâèì çíèæåííÿì âàðòîñò³ íà ‡ 76043 àáî
‡ 639 44 äëÿ êîæíîãî âèñîêîçàëåæíîãî ïàö³ºíòà.
Îêóïí³ñòü ðåàá³ë³òàö³¿ áóëà äîñÿãíóòà ïðîòÿãîì
14,2 àáî 15,6 ì³ñÿö³â43,44. Âàæëèâî çàçíà÷èòè, ùî
î÷³êóâàíà ð³÷íà åêîíîì³ÿ íà îäíîãî ïàö³ºíòà â ö³é
ñóòòºâî çàëåæí³é ãðóï³ ïàö³ºíò³â ïðè íàäõîäæåíí³
äî ñòàö³îíàðíî¿ ðåàá³ë³òàö³¿ ìîæå ñÿãàòè 50 000ˆ44.
Äîìàøíÿ ïðîãðàìà íåéðîïîâåä³íêîâî¿ ðåàá³ë³òàö³¿
ï³ä ÷àñ ï³äãîñòðî¿ ôàçè ÷åðåïíî-ìîçêîâî¿ òðàâìè
ïðèçâåëà äî åêîíî쳿 ‡ 1,13 ìëí. äëÿ òèõ, õòî îòðè-
ìóº ðåàá³ë³òàö³þ ïðîòÿãîì ïåðøîãî ðîêó ï³ñëÿ
÷åðåïíî-ìîçêîâî¿ òðàâìè ³ äîñÿãຠ‡ 0,86 ìëí. äëÿ
òèõ, õòî îòðèìóº ðåàá³ë³òàö³þ ï³çí³øå ï³ñëÿ òðàâ-
ìè (>1 ðîêó)45. Ö³ âèñíîâêè ðîçøèðþþòü âèãîäè
ðåàá³ë³òàö³éíèõ ïîñëóã (âêëþ÷àþ÷è ïðîãðàìè
ÔÐÌ), çà ìåæ³ ëèøå ôóíêö³îíàëüíèõ ïîêðàùåíü,
àëå òàêîæ, ÿê âàæëèâ³ çàîùàäíèêè êîøò³â äëÿ
ñ³ìåé, äëÿ ñòîðîíí³õ ïëàòíèê³â, à òàêîæ äëÿ ñóñ-
ï³ëüñòâà â ö³ëîìó. Ðåçóëüòàòè ùîäî ö³íè-åôåêòèâ-
íîñò³ ïîøèðþþòüñÿ íà ðåàá³ë³òàö³þ â ð³çíèõ çàê-
ëàäàõ òà äëÿ ð³çíèõ ñòàí³â, ùî ïðèçâîäÿòü äî
îáìåæåíü æèòòºä³ÿëüíîñò³. Íàïðèêëàä, äâà äîñ-
ë³äæåííÿ âèÿâèëè ïåðåâàãè ìóëüòèäèñöèïë³íàðíî¿
56 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ðåàá³ë³òàö³¿ áîëþ â ïëàí³ åêîíî쳿 êîøò³â. Áóëà
çíà÷íà åêîíîì³ÿ âèòðàò ç³ çìåíøåííÿì íà 42,98
ê³ëüêîñò³ äí³â çíàõîäæåííÿ íà ë³êàðíÿíîìó ëèñò³
ïðîòÿãîì îäíîãî ðîêó ïîð³âíÿëüíî ç ïàö³ºíòàìè, ÿê³
îòðèìóâàëè ñòàíäàðòíó äîïîìîãó46. ²íøå äîñë³ä-
æåííÿ âèçíà÷èëî åêîíîì³þ â ðîçì³ð³ 27 119 äîëàð³â
ÑØÀ íà ðîäèíó â íàñòóïíîìó ðîö³ ï³ñëÿ íàäõîä-
æåííÿ íà òðèòèæíåâó ì³æäèñöèïë³íàðíó ïðîãðàìó
ïåä³àòðè÷íî¿ ðåàá³ë³òàö³¿ õðîí³÷íîãî áîëþ ç ô³çè÷-
íîþ òåðàﳺþ, åðãîòåðàﳺþ, ãðóïîâèìè âïðàâàìè
íà çåìë³ òà â âîä³, ðåêðåàö³éíîþ òåðàﳺþ òà ïñè-
õîëîã³÷íîþ òåðàﳺþ. Áóëè òàêîæ ñóòòºâ³ ñêîðî-
÷åííÿ òðèâàëîñò³ ãîñï³òàë³çàö³¿, â³äâ³äóâàííÿ
ë³êàð³â, ïîñëóã ô³çè÷íî¿ òà åðãîòåðàﳿ, â³äâ³äóâàí-
íÿ ïñèõîòåðàïåâò³â òà ïðîïóñê äí³â ðîáîòè áàòü-
êàìè 47 . Òàêîæ áóëî äîâåäåíî äîâãîñòðîêîâó
åêîíîì³÷íó åôåêòèâí³ñòü êàðä³î-ëåãåíåâî¿ ðåàá³ë³-
òàö³¿48,49. ²ñíóþòü òàêîæ ïåðåâàãè â ïëàí³ ñïðèéíÿò-
òÿ îáìåæåíü æèòòºä³ÿëüíîñò³, çíà÷íî ìåíøî¿
ê³ëüêîñò³ ãîäèí â³äñóòíîñò³ íà ðîáî÷îìó ì³ñö³
âíàñë³äîê õâîðîáè, êîëè êîîðäèíîâàíà òà àäàïòî-
âàíà ïðîãðàìà ïðîôåñ³éíî¿ ðåàá³ë³òàö³¿ (ÏÐ) íà-
äàºòüñÿ ìóëüòè-ïðîôåñ³éíîþ êîìàíäîþ, ÿêà
ñï³ëüíî ïðàöþº ï³ä êåð³âíèöòâîì ë³êàðÿ ÔÐÌ ïî-
ð³âíÿëüíî ç êîíòðîëüíîþ ãðóïîþ ïðè ì’ÿçîâî-ñêå-
ëåòíèõ ðîçëàäàõ. Çàãàëüíà ñóìà íåïðÿìèõ çàîùàä-
æåíü ñêëàëà áëèçüêî 1366 äîëàð³â ÑØÀ íà îñîáó
ïðîòÿãîì øåñòè ì³ñÿö³â òà 10666 äîëàð³â ÑØÀ íà
îñîáó ï³ñëÿ ðîêó â ãðóï³ âòðó÷àííÿ50. Ïðîãðàìè
ðåàá³ë³òàö³¿ â ãðîìàä³ äëÿ äîâãîòðèâàëîãî äîãëÿ-
äó ó ñëàáêèõ ëþäåé ïîõèëîãî â³êó òàêîæ áóëè âèç-
íàí³ åêîíîì³÷íî åôåêòèâíèìè ç âèñîêèì ñòóïåíåì
çàäîâîëåííÿ ïàö³ºíò³â. Îäíàê ó ïîð³âíÿíí³ ç òðà-
äèö³éíîþ ñòàö³îíàðíîþ ðåàá³ë³òàö³ºþ, öå íå çìåí-
øèëî òðèâàëîñò³ ïåðåáóâàííÿ â ë³êàðí³ àáî ïîâòîð-
íèõ íàäõîäæåíü äî ë³êàðí³51.
Äîñë³äæåííÿ ïðîôåñ³éíèõ ì’ÿçîâî-ñêåëåòíèõ
ðîçëàä³â ïîêàçàëî, ùî ðàííÿ ðåàá³ë³òàö³ÿ ìîæå
ïðèçâåñòè äî åêîíî쳿 êîøò³â íà ìåäè÷í³ âèòðàòè
äî 64% òà çíèæåííÿ âèòðàò íà îáìåæåííÿ æèòòº-
ä³ÿëüíîñò³ äî 80%. Âàðò³ñòü ðåàá³ë³òàö³¿ òàêîæ
áóëà íà 56% íèæ÷à ïðè ðàííüîìó ïî÷àòêó òà î÷³-
êóâàíîþ åêîíî쳺þ âèòðàò ïðèáëèçíî ó 170000
äîëàð³â ÑØÀ íà îäèí âèïàäîê52. ²íøå äîñë³äæåí-
íÿ ðîçðàõóâàëî äîâãîñòðîêîâó åêîíîì³þ ÷èñòèõ
âèòðàò ó ðîçì³ð³ 817836 äîë. ÑØÀ53.
Íåäàâíº äîñë³äæåííÿ, ïðèñâÿ÷åíå ìíîæèííîìó
ñêëåðîçó, ï³äêðåñëþº ñóòòºâ³ â³äì³ííîñò³ ì³æ ïàö³-
ºíòàìè ç íèçüêèì ïîêàçíèêîì îáìåæåíü æèòòºä³-
ÿëüíîñò³ òà òèìè, õòî ìຠâèñîêèé ïîêàçíèê îáìå-
æåíü æèòòºä³ÿëüíîñò³ – ó îñòàíí³õ áóëà çíà÷íî
á³ëüøà ê³ëüê³ñòü â³çèò³â çà ìåäè÷íîþ äîïîìîãîþ
òà á³ëüøà ê³ëüê³ñòü ãîñï³òàë³çàö³é, ã³ðøà ÿê³ñòü
æèòòÿ, ïîâ’ÿçàíà ç³ çäîðîâ’ÿì, á³ëüø ñåðéîçí³ ïðî-
áëåìè íà ðîáîò³, á³ëüøå áåçðîá³òòÿ òà íåîáõ³äí³ñòü
¹2(2) *2018
 ÐÎÇÄ²Ë 2 – ×ÎÌÓ ÐÅÀÁ²Ë²ÒÀÖ²ß ÏÎÒвÁÍÀ ²ÍÄȲÄÓÓÌÓ ÒÀ ÑÓÑϲËÜÑÒÂÓ
çì³íè àáî çóïèíêè ðîáîòè, ³ öå âñå çá³ëüøèëî ïðÿì³
òà íåïðÿì³ âèòðàòè íà îáìåæåííÿ æèòòºä³ÿëü-
íîñò³54. Äî öüîãî ðîçðàõóíêó ñë³ä äîäàâàòè äîäàò-
êîâ³ íåïðÿì³ âèòðàòè íà îáìåæåííÿ æèòòºä³ÿëü-
íîñò³ â 910 ì³ëüéîí³â ºâðî (ùî ñòàíîâèòü ~ 0,5%
ÂÂÏ) äëÿ ïîðòóãàëüñüêîãî íàñåëåííÿ ç ðåâìàòè÷-
íèìè çàõâîðþâàííÿìè â 2013 ðîö³ âíàñë³äîê äîñò-
ðîêîâîãî âèõîäó íà ïåíñ³þ. Ö³ öèôðè âêëþ÷àþòü
âèñîêó ð³÷íó âàðò³ñòü ÷åðåç âòðà÷åí³ ðîêè æèòòÿ
â ïðàöåçäàòíîìó ñòàí³55.
³äîìî, ùî â äåÿêèõ âèïàäêàõ ðåàá³ë³òàö³éí³
âòðó÷àííÿ ñòâîðþþòü äîäàòêîâ³ âèòðàòè. Îäíàê
âîíè ìîæóòü áóòè ïîâ’ÿçàí³ ç ïîë³ïøåííÿì
êë³í³÷íèõ ðåçóëüòàò³â.  äåÿêèõ ³íøèõ ñèòóàö³ÿõ
ðåàá³ë³òàö³éí³ âòðó÷àííÿ ìîæóòü ñïðè÷èíèòè
ïîä³áí³ êë³í³÷í³ ðåçóëüòàòè ïðè ìåíøèõ âèòðàòàõ.
Ðåàá³ë³òàö³éí³ çàõîäè ìîæóòü ñïðè÷èíèòè çàîùàä-
æåííÿ ³íøèõ âèòðàò íà îõîðîíó çäîðîâ’ÿ àáî ñîö³-
àëüí³ ïîñëóãè ÷åðåç ï³äòðèìêó ïðîäóêòèâíîñò³, ÿêà
áóëà âòðà÷åíà âíàñë³äîê ³ñíóþ÷îãî ñòàíó çäîðî-
â’ÿ ÷è îáìåæåííÿ æèòòºä³ÿëüíîñò³.
Âïëèâ â³äñóòíîñò³ ðåàá³ë³òàö³¿
Ùî â³äáóäåòüñÿ, ÿêùî ðåàá³ë³òàö³ÿ òà, çîêðåìà,
ïîñëóãè ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
(ÔÐÌ) íå íàäàþòüñÿ? Âèëó÷åííÿ ¿õ ìîæå çäàâà-
òèñÿ ìåíø âàðò³ñíèì, àëå ÷è íå ñêàñîâóºòüñÿ öå
çìåíøåííÿ âèòðàò çá³ëüøåííÿì âèòðàò íà îõîðî-
íó çäîðîâ’ÿ òà ñîö³àëüíó äîïîìîãó â ³íøèõ
ì³ñöÿõ?43 Îòæå, íàäàííÿ ãàðíî¿ ðåàá³ë³òàö³¿ º âàæ-
ëèâèì àñïåêòîì ïðè ïëàíóâàíí³ òà îá´ðóíòóâàíí³
ïîñëóã ÔÐÌ, ÿê äëÿ îñîáè òà éîãî àáî ¿¿ ðîäèíè /
äîãëÿäà÷à, òàê ³ äëÿ ³íøèõ ñëóæá òà ñóñï³ëüñòâà
â ö³ëîìó. ³äîìî, ùî êîøòè, âèòðà÷åí³ íà ðåàá³ë³-
òàö³þ, â³äíîâëþþòüñÿ ç ï’ÿòè-äåâ’ÿòèêðàòíèìè
çàîùàäæåííÿìè, ³ ðåàá³ë³òàö³ÿ åôåêòèâíà ïðîòÿãîì
óñ³õ ôàç ñòàí³â çäîðîâ’ÿ 22,23. Òàêîæ â³äîìî, ùî
ñïåö³àë³çîâàíà ðåàá³ë³òàö³ÿ (ÿêà íàäàºòüñÿ ïîñëó-
ãàìè ÔÐÌ) º äóæå ðåíòàáåëüíîþ äëÿ âñ³õ íåâðî-
ëîã³÷íèõ ñòàí³â, çàáåçïå÷óþ÷è çíà÷íó åêîíîì³þ
âèòðàò íà ïîòî÷íó äîïîìîãó, îñîáëèâî ó ïàö³ºíò³â
ç âèñîêèì ð³âíåì çàëåæíîñò³43. Ñëóæáè ÔÐÌ çàé-
ìàþòüñÿ ðåàá³ë³òàö³éíèìè ïîòðåáàìè ëþäåé ³ç
êîìïëåêñíèìè ïîòðåáàìè, ³ òîìó âîíè ñïîæèâàþòü
çíà÷í³ ðåñóðñè â îõîðîí³ çäîðîâ’ÿ. Íàïðèêëàä, ïà-
ö³ºíòè ç ³íñóëüòîì òà ñïàñòè÷í³ñòþ áåçïîñåðåäíüî
êîøòóþòü ó ÷îòèðè ðàçè á³ëüøå, í³æ ò³, ùî íå ìà-
þòü ñïàñòè÷íîñò³56.
Ïðèêëàäè ïåðåâàã ïîñëóã ç ÔÐÌ – öå:
– ðàíí³é ìåíåäæìåíò ñïàñòè÷íîñò³ ìîæå çàïî-
á³ãòè êîíòðàêòóðàì òà çìåíøèòè ÷àñ, âèòðà÷å-
íèé íà ïîäàëüøó ñòàö³îíàðíó ðåàá³ë³òàö³þ57;
– ðàííÿ âèïèñêà ç ï³äòðèìêîþ ï³ñëÿ ³íñóëüòó
çìåíøèòü çàãàëüí³ âèòðàòè íà îõîðîíó
çäîðîâ’ÿ 58;
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
– ïîñëóãè ÔÐÌ ïîâ’ÿçàí³ íå ëèøå ç á³ëüø âèñî-
êèì ð³âíåì ïîâåðíåííÿ äî ïðàö³, àëå é ï³äòðè-
ìóþòü ëþäåé íà ðîáî÷îìó ì³ñö³ ÷åðåç òå, ùî
ïðîôåñ³éíà ðåàá³ë³òàö³ÿ ìຠâðàõîâóâàòè âñ³
ôàêòîðè, íåîáõ³äí³ äëÿ ìàêñèì³çàö³¿ éìîâ³ðíîñò³
ñòàëîãî ïîâåðíåííÿ äî ïðàö³59.
Ðåàá³ë³òàö³éíèé ïîòåíö³àë ëþäèíè íå ìîæå ðîç-
ãëÿäàòèñü îêðåìî â³ä òîãî, ùî áóëî á ðåçóëüòàòîì
áåç ðåàá³ë³òàö³¿. Ïèòàííÿ, ÿêå ñïåö³àë³çîâàíà ðåà-
á³ë³òàö³ÿ íàìàãàºòüñÿ âèð³øèòè, ïîëÿãຠâ òîìó,
«×è áóäå ïàö³ºíò îòðèìóâàòè òàêó âèãîäó â³ä ðåà-
á³ë³òàö³éíî¿ ïðîãðàìè, ÿêó á ïàö³ºíò íå ìàâ, ÿêáè
â³äíîâëåííÿ ïîêëàäàëîñü íà âèïàäîê?» Ïðèðîäíèé
ðîçâèòîê ïîðóøåíü òà, ÿê íàñë³äîê, îáìåæåíü æèò-
òºä³ÿëüíîñò³ òà íåäîë³êè â³ä³ãðàþòü îñíîâíó ðîëü
â ìîæëèâîìó ðåçóëüòàò³ ï³ñëÿ ðåàá³ë³òàö³¿. Äåÿê³
ñòàíè â³äíîâëþþòüñÿ ñïîíòàííî òà ðàííº âòðó÷àí-
íÿ ìîæå ïðèçâåñòè äî ïîìèëêîâîãî âðàæåííÿ, ùî
òåðàï³ÿ áóëà åôåêòèâíîþ60,61. Ç ³íøîãî áîêó, ðàííº
âòðó÷àííÿ ìîæå áóòè ïîâ’ÿçàíå ç ïîêðàùåíèì
ðåçóëüòàòîì, íàâ³òü ÿêùî ïîâíå â³äíîâëåííÿ íå
â³äáóâàºòüñÿ 62.
Æèòòÿ ëþäåé ç ïîñò³éíèìè îáìåæåííÿìè æèò-
òºä³ÿëüíîñò³ òà ¿õí³õ ñ³ìåé ìîæå ïîêðàùèòèñü
øëÿõîì ðåàá³ë³òàö³¿, àëå, ùî á³ëüø âàæëèâî, íà-
ñë³äêîì òîãî, ùî âîíè íå ìàþòü ðåàá³ë³òàö³¿, ìîæå
áóòè çìåíøåííÿ íåçàëåæíîãî ôóíêö³îíóâàííÿ òà
ÿêîñò³ æèòòÿ63. Ó ë³êàðíÿõ ãîñòðî¿ äîïîìîãè áàãà-
òî ïðîáëåì, ùî ìîæóòü áóòè âèïðàâëåíèìè, òàê³
ÿê õàð÷óâàííÿ, êîâòàííÿ, ïèòàííÿ ìîá³ëüíîñò³ òà
îáëàäíàííÿ ìîæóòü íå ðîçãëÿäàòèñÿ, îñê³ëüêè
îñíîâíèì ôîêóñîì íåìèíó÷å º ë³êóâàííÿ ïåðâèí-
íîãî ïîðóøåííÿ. Ñàìå òóò ë³êàð³ ÔÐÌ ìîæóòü äî-
ïîìîãòè ó çàïîá³ãàíí³ óñêëàäíåíü òà ó çàáåçïå-
÷åíí³ îïòèìàëüíîãî ð³âíÿ ôóíêö³îíóâàííÿ64. Ó ðàç³
â³äñóòíîñò³ ðåàá³ë³òàö³¿ ìîæóòü âèíèêàòè óñêëàä-
íåííÿ òà âòðàòà ôóíêö³¿, òà âèïèñêà ìîæå çàòðè-
ìàòèñü. Ïðîòå, çàêëàäè îõîðîíè çäîðîâ’ÿ ìàþòü
ñòàòóòí³ çîáîâ’ÿçàííÿ íàäàâàòè ïîñëóãè ç ðåàá³ë³-
òàö³¿ äëÿ çàäîâîëåííÿ ïîòðåá îõîðîíè çäîðîâ’ÿ óñ³õ
ïàö³ºíò³â65,66.
Íàñòóïíå ìîæíà â³äáóòèñÿ çà â³äñóòíîñò³ ðåà-
á³ë³òàö³¿ ïðè ð³çíèõ ñòàíàõ:
– çíåðóõîìëåí³ñòü, ó òîìó ÷èñë³ ñëàáê³ñòü, êàð-
ä³î-ðåñï³ðàòîðíà íåäîñòàòí³ñòü, âòðàòà ì’ÿç³â,
ïðîëåæí³, ñïàñòè÷í³ñòü, êîíòðàêòóðè òà îñòåî-
ïîðîç;
– á³ëü;
– ïðîáëåìè õàð÷óâàííÿ;
– ïðîáëåìè êîâòàííÿ;
– ïðîáëåìè ñå÷îâîãî ì³õóðà òà êèøê³âíèêà (çàê-
ðåïè òà íåòðèìàííÿ);
– ïðîáëåìè êîìóí³êàö³¿;
– ï³çíàâàëüí³ ïðîáëåìè òà íåçäàòí³ñòü îòðèìàòè
êîðèñòü â³ä íàâ÷àííÿ;
57
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
– ïðîáëåìè ç íàñòðîºì òà ïîâåä³íêîþ;
– ïîãàíå çäîðîâ’ÿ òà ñèñòåìí³ çàõâîðþâàííÿ
âíàñë³äîê ð³çíèõ ïðè÷èí, íàïð. ïðîáëåìè ç ñå-
÷îâèì òðàêòîì ³, êàðä³î-ðåñï³ðàòîðí³ ïðîáëåìè,
öóêðîâèé ä³àáåò;
– óñêëàäíåííÿ îñíîâíèõ ñòàí³â.
Çíàþ÷è öå, ñëóæáè ÔÐÌ ïîâèíí³ áóòè çàëó÷åí³
äî äîâãîòðèâàëîãî ñïîñòåðåæåííÿ çà ïàö³ºíòàìè,
êîëè âîíè ïåðåõîäÿòü ó æèòòÿ â ãðîìàä³, ùîá çà-
ïîá³ãòè:
– âòîðèííèì ïðîáëåìàì ç³ çäîðîâ’ÿì òà ñîö³-
àëüí³é ³çîëÿö³¿;
– âèñíàæåííþ äîãëÿäà÷³â çàâäÿêè òÿãàðþ äîãëÿ-
äó ³ òèì ñàìèì ðóéíóâàííþ ñèòóàö³¿ âäîìà;
– íåîáãðóíòîâàíèì âèêëèêàì ë³êàð³â çàãàëüíî¿
ïðàêòèêè àáî ñîö³àëüíèõ ïðàö³âíèê³â;
– ïîâòîðíèì ãîñï³òàë³çàö³ÿì äî ë³êàðí³ çà íå-
â³äêëàäíèìè ïðè÷èíàìè;
– íåïîòð³áíèì ñêåðóâàííÿì äî ïðîãðàì äîìàø-
íüîãî àáî ñåñòðèíñüêîãî äîãëÿäó;
– íåâ³äïîâ³äíîìó òà íåâ÷àñíîìó ïðèçíà÷åííþ
òåõí³÷íèõ çàñîá³â ðåàá³ë³òàö³¿;
– íåçäàòíîñò³ îíîâëåííÿ òåõí³÷íèõ çàñîá³â ðåàá³-
ë³òàö³¿ ó ñâ³òë³ ïðîãðåñèâíèõ òåõíîëîã³é, íà-
ïð.íåéðîïðîòåçè.
Öåé êîðîòêèé òåêñò íå ìîæå äåòàë³çóâàòè íà-
ñë³äêè â³äñóòíîñò³ ðåàá³ë³òàö³¿, àëå çàãàëüíèé ðå-
çóëüòàò ìîæå ïîëÿãàòè â òîìó, ùî ëþäèíà ÷àñòî
çàëèøàºòüñÿ ç ìåíøîþ ôóíêö³îíàëüíîþ çäàòí³ñòþ
òà ÿê³ñòþ æèòòÿ. Öå áóëî ïðîäåìîíñòðîâàíî â
óìîâàõ ãðîìàäè ÷åðåç âòðàòó ðåñóðñ³â, âèòðà÷å-
íèõ íà ãîñòð³ òà ï³äãîñòð³ çàêëàäè. ʳëüêà ³í³ö³àòèâ
âèçíàëè öþ â³äì³íí³ñòü ó ìîæëèâîñòÿõ ï³ñëÿ òîãî,
ÿê ïàö³ºíò³â âèïèñàëè, à ì³æíàðîäíà åêñïåðòíà
ãðóïà âèãîòîâèëà ïðîñòèé, çðó÷íèé ó êîðèñòóâàíí³
êîíòðîëüíèé ñïèñîê, ÿêèé âèêîðèñòîâóâàâ âèæèâ-
øèõ ï³ñëÿ ³íñóëüòó çà ìîäåëü67. Öåé êîíòðîëüíèé
ñïèñîê çàðàç º âàë³äîâàíèì òà âèçíàíèé êîðèñíèì,
òîæ â³í ìîæå âèêîðèñòîâóâàòèñÿ, ÿê çàñ³á âèçíà-
÷åííÿ ïðîáëåì äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³-
ÿëüíîñò³, ÿê³ æèâóòü âäîìà àáî â ³íñòèòóö³éíèõ
óìîâàõ68. Äîñâ³ä ïîëÿãຠâ òîìó, ùî áàãàòî ëþäåé
ñòðàæäàþòü íà óñêëàäíåííÿ, ÿêèõ ìîæíà çàïîá³ã-
òè, ÷åðåç â³äñóòí³ñòü ïîñëóã ðåàá³ë³òàö³¿ òà îõîðî-
íè çäîðîâ’ÿ, â ðåçóëüòàò³ âîíè âèòðà÷àþòü á³ëüøå
ðåñóðñ³â (íàïð. õ³ðóðã³÷íå âòðó÷àííÿ) äëÿ ïîêðà-
ùåííÿ ñèòóàö³¿ àáî ïðîñòî ïîâòîðþþòü ë³êóâàííÿ,
çà äîïîìîãîþ ÿêèõ ïàö³ºíòè ïîâèíí³ “ðóõàòèñü
äàë³”.
Îïèñóâàííÿ íàñë³äê³â â³äñóòíîñò³ ðåàá³ë³òàö³¿ º
âàæëèâèì ïèòàííÿì ó ïðîñóâàíí³ òà îá´ðóíòóâàíí³
âèñîêîêâàë³ô³êîâàíèõ ïîñëóã ÔÐÌ.
58 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
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59
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57. Verplancke D., Snape S., Salisbury C.F., Jones P.W., Ward A.B.
A randomized controlled trial of botulinum toxin on lower limb
spasticity following acute acquired severe brain injury. Clin.
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58. Fjaertoft H., Indredavik B., Magnussen J., Johnsen R. Early
supported discharge for stroke patients improves clinical
outcome. Does it also reduce use of health services and costs?
One-year follow-up of a randomized controlled trial.
Cerebrovasc Dis. Basel. Switz. 2005;19(6):376–83.
59. Fadyl J.K., McPherson K.M., Schleter P.J., Turner-Stokes
L. Factors contributing to work-ability for injured workers:
literature review and comparison with available measures.
Disability & Rehabilitation. 2010;
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9;9(20):2155–62.
61. Grahn B.E.M., Borgquist L.A., Ekdahl C.S. Rehabilitation
benefits highly motivated patients: a six-year prospective cost-
effectiveness study. Int J. Technol. Assess. Health. Care.
2004;20(2):214–21.
62. Wade D. Investigating the effectiveness of rehabilitation
professions – a misguided enterprise? Clin Rehabil. 2005
Jan;19(1):1–3.
63. Quintard B., Croze P., Mazaux J.M., Rouxel L., Joseph P.A.,
Richer E., et al. Life satisfaction and psychosocial outcome in
severe traumatic brain injuries in Aquitaine. Ann Readaptation
Med. Phys. Rev. Sci. Soc. Francaise Reeducation Fonct
Readaptation Med. Phys. 2002 Nov;45(8):456–65.
64. McLellan D.L. Targets for Rehabiliation. British Medical
Journal. 1985;1514.
65. Nybo T., Sainio M., Muller K. Stability of vocational outcome
in adulthood after moderate to severe pre-school brain injury.
Journal of International Psychological Society. 2004;719–23.
66. Association of British Neurologists, NeuroConcern Group of
Medical Charities, British Society of Rehabilitation Medicine.
Neurological Rehabilitation in the United Kingdom. 1992.
67. Philp I., Brainin M., Walker M.F., Ward A.B., Gillard P.,
Shields A.L., et al. Development of a Post-stroke Checklist
to Standardize Follow-up Care for Stroke Survivors. Journal
of Stroke & Cardiovascular Diseases. 2013;e173–80.
68. Ward A.B., Chen C., Norrving B., Gillard P., Walker M.F.,
Blackburn S., et al. Evaluation of the Post Stroke Checklist: a
pilot study in the United Kingdom and Singapore. Int. J. Stroke
Off J. Int. Stroke Soc. 2014 Oct;9 Suppl A100:76–84.

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Anthony B Ward,
Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner,
Carlotte Kiekens, Sasa Moslavac, Enrique Varela-Donoso, Mauro Zampolini, Stefano Negrini.
• Ó÷àñíèêè: Pedro Cantista, Carlotte Kiekens, Anthony B Ward, Mauro Zampolini, Karol Hornacek, Aydan
Oral, Lloyd Bradley, Rory O‘Connor, Christoph Gutenbrunner, Andrew J. Haig, Geraldine Jacquemin, Vera
Neumann, Peter Takac.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ

60 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐM) â ªâðîï³
Ðîçä³ë 3 – Ïåðâèííà ìåäè÷íà ñïåö³àëüí³ñòü: îñíîâè ÔÐÌ
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
 êîíòåêñò³ Á³ëî¿ êíèãè ô³çè÷íî¿ ³ ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ÔÐÌ) â ªâðîï³, öåé äîêóìåíò ïðèñâÿ÷åíèé îñíîâíèì
êîíöåïö³ÿì â îñíîâ³ ñïåö³àëüíîñò³ ÔÐÌ. Öå íåâ³äì³íí³ ñêëàäîâ³, ÿê³ ðîáëÿòü ÔÐÌ ïåðâèííîþ ìåäè÷íîþ ñïåö³àëüí³-
ñòþ, ÿêà â³äð³çíÿºòüñÿ â³ä óñ³õ ³íøèõ ìåäè÷íèõ ñïåö³àëüíîñòåé, à ë³êàðÿ ÔÐÌ – ïåðâèííèì ìåäè÷íèì ñïåö³àë³ñòîì ñåðåä
ôàõ³âö³â ðåàá³ë³òàö³¿. Îñíîâí³ ïîíÿòòÿ, ÿê³ áóäóòü ðîçãëÿíóò³ â ö³é ãëàâ³, âêëþ÷àþòü:
– ÔÐÌ º ñïåö³àëüí³ñòþ, îð³ºíòîâàíîþ íà ïåðñîíó / ôóíêö³îíóâàííÿ, ùî ðîáèòü öþ ñïåö³àëüí³ñòü â³äì³ííîþ â³ä ìå-
äè÷íèõ ñïåö³àëüíîñòåé, îð³ºíòîâàíèõ íà îðãàí / õâîðîáó, àáî ë³êóâàííÿ / â³ê;
– ˳êàð³ ÔÐÌ ìàþòü ìåäè÷í³ îáîâ’ÿçêè, ÿê ³ âñ³ ³íø³ ìåäè÷í³ ñïåö³àë³ñòè, àëå ç äîäàòêîâîþ ñïåöèô³êîþ ïðîâåäåííÿ
ôóíêö³îíàëüíîãî îö³íþâàííÿ;
– ßê ³ ³íø³ ñïåö³àë³ñòè, ë³êàð³ ÔÐÌ çàáåçïå÷óþòü áåçïîñåðåäíº ë³êóâàííÿ, àëå âîíè òàêîæ î÷îëþþòü ìóëüòè-ïðî-
ôåñ³éí³ ðåàá³ë³òàö³éí³ êîìàíäè, ÿê³ ïðàöþþòü ñï³ëüíî ç ³íøèìè ôàõ³âöÿìè òà ìåäè÷íèìè ñïåö³àë³ñòàìè;
– Çàâäÿêè ï³äõîäó, îð³ºíòîâàíîìó íà ôóíêö³þ, ÔÐÌ âèêîðèñòîâóº ìóëüòèìîäàëüíèé ï³äõ³ä, ùî îõîïëþº øèðîêèé
ñïåêòð ³íñòðóìåíò³â âòðó÷àííÿ (÷àñòî íàäàþòüñÿ ³íøèìè ôàõ³âöÿìè ç ðåàá³ë³òàö³¿) ³ çàéìàºòüñÿ ìåíåäæìåíòîì óñ³õ
çàõâîðþâàíü ëþäèíè (ñòàí³â çäîðîâ’ÿ), îñê³ëüêè âîíà ôîêóñóºòüñÿ íà çìåíøåíí³ ñòóïåíþ ïîðóøåíü ³ îáìåæåíü
àêòèâíîñò³, ùîá ìàêñèìàëüíî ðîçøèðèòè ìîæëèâó ó÷àñòü ïàö³ºíò³â;
– Îñê³ëüêè ÔÐÌ ´ðóíòóº ñâîþ ðîáîòó íà ôóíêö³îíóâàíí³, âîíà ìຠòðàíñâåðçàëüíó ðîëü äëÿ ³íøèõ ñïåö³àëüíîñòåé:
âîíà ïåðåêðèâຠê³ëüêî ç íèõ, ðîçä³ëÿþ÷è ÷àñòèíó ¿õ çíàíü, àëå âîíà òàêîæ ïîâí³ñòþ íåçàëåæíà â³ä óñ³õ ç íèõ,
îñê³ëüêè âîíà çàñíîâàíà íà ³íøîìó îêðåìîìó îáñÿç³ çíàíü, ÿêèé òàêîæ º òðàíñâåðçàëüíèì äî ³íøèõ ñïåö³àëüíîñòåé;
– ÔÐÌ çîñåðåäæåíà íà ïåðñîí³, à í³ íà õâîðîáàõ, í³ íà çàêëàäàõ; ôàêòè÷íî, ÔÐÌ íå ò³ëüêè º òðàíñâåðçàëüíîþ äî
ñïåö³àëüíîñòåé, àëå ³ äî çàêëàä³â, äå íàäàºòüñÿ äîïîìîãà, òà ë³êàð³ ÔÐÌ ïîâèíí³ çíàòè ö³ ð³çí³ ðåàëüíîñò³: îñîáè ç
îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà ç äîâãîòðèâàëèìè ñòàíàìè çäîðîâ’ÿ ôàêòè÷íî ïåðåì³ùóþòüñÿ âñåðåäèí³ íàö³î-
íàëüíèõ ñèñòåì îõîðîíè çäîðîâ’ÿ ì³æ ð³çíèìè çàêëàäàìè äëÿ çäîáóòòÿ íàéêðàùîãî ìîæëèâîãî ôóíêö³îíóâàííÿ òà
ó÷àñò³ ÷åðåç â³äïîâ³äíèé ïðîöåñ ðåàá³ë³òàö³¿.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 3. A primary medical specialty: the fundamentals of PRM.
Eur J Phys Rehabil Med. 2018 Apr;54(2):177-185.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 3. Ïåðâèííà ìåäè÷íà ñïåö³àëüí³ñòü: îñíîâè
ÔÐÌ. Óêðà¿íñüêèé æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 61-69.
Êëþ÷îâ³ ñëîâà: Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà, ªâðîïà, ä³àãíîç, îñîáà, êîìàíäà ùî íàäຠäîïîìîãó ïàö³ºíòó.

Ââåäåííÿ àëüí³ñòþ. Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïîíÿòòÿ

Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî
óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³î-
íàëüíîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòå-
ð³àë³â äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìó-
âàííÿ ïðî ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â
ðåàá³ë³òàö³¿ òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà
âàæëèâîñò³ ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ ñïåö³-
ÔÐÌ, ÷îìó ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì ëþäÿì
³ ñóñï³ëüñòâó, îñíîâè ÔÐÌ, ³ñòîð³ÿ ñïåö³àëüíîñò³
ÔÐÌ, ñòðóêòóðà ³ ä³ÿëüí³ñòü îðãàí³çàö³é ÔÐÌ â
ªâðîï³, çíàííÿ ³ íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà
êë³í³÷íèõ êîìïåòåíòíîñòåé ÔÐÌ, ì³ñöå ñïåö³àëü-
íîñò³ ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ ³
ñóñï³ëüñòâ³, îñâ³òà òà áåçïåðåðâíèé ïðîôåñ³éíèé
ðîçâèòîê ë³êàð³â ÔÐÌ, îñîáëèâîñò³ òà ïðîáëåìè
íàóêè òà äîñë³äæåíü â ÔÐÌ òà ïðîáëåìè òà ïåðñ-
ïåêòèâè ìàéáóòíüîãî ÔÐÌ.
Öÿ ãëàâà º íîâîþ ó êîíòåêñò³ Á³ëèõ êíèã, âèðîá-
ëåíèõ äîòåïåð, ³ áóëà ââåäåíà äëÿ òîãî, ùîá êðà-
ùå çîñåðåäèòè óâàãó íà áàçîâèõ êîíöåïö³ÿõ â îñ-

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 61
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
íîâ³ ñïåö³àëüíîñò³ ÔÐÌ. Íàñïðàâä³ öå ñóòòºâ³ ñêëà-
äîâ³, ÿê³ ðîáëÿòü:
– ÔÐÌ ïåðâèííîþ ìåäè÷íîþ ñïåö³àëüí³ñòþ,
â³äì³ííîþ â³ä óñ³õ ³íøèõ ìåäè÷íèõ ñïåö³àëüíî-
ñòåé;
– ë³êàðÿ ÔÐÌ – ïåðâèííèì ìåäè÷íèì ñïåö³àë³-
ñòîì ñåðåä ôàõ³âö³â ðåàá³ë³òàö³¿.
Áàçîâ³ êîíöåïö³¿, ÿê³ áóäóòü îáãîâîðþâàòèñü â
ö³é ãëàâ³, âêëþ÷àþòü:
– ÔÐÌ º ñïåö³àëüí³ñòþ, îð³ºíòîâàíîþ íà ïåðñî-
íó / ôóíêö³îíóâàííÿ, ùî ðîáèòü öþ ñïåö³àëüí³ñòü
â³äì³ííîþ â³ä ìåäè÷íèõ ñïåö³àëüíîñòåé, îð³ºí-
òîâàíèõ íà îðãàí / õâîðîáó, àáî ë³êóâàííÿ / â³ê;
– ˳êàð³ ÔÐÌ ìàþòü ìåäè÷í³ îáîâ’ÿçêè, ÿê ³ âñ³
³íø³ ìåäè÷í³ ñïåö³àë³ñòè, àëå ç äîäàòêîâîþ ñïåöè-
ô³êîþ ïðîâåäåííÿ ôóíêö³îíàëüíîãî îö³íþâàííÿ;
– ßê ³ ³íø³ ñïåö³àë³ñòè, ë³êàð³ ÔÐÌ çàáåçïå÷óþòü
áåçïîñåðåäíº ë³êóâàííÿ, àëå âîíè òàêîæ î÷îëþ-
þòü ìóëüòè-ïðîôåñ³éí³ ðåàá³ë³òàö³éí³ êîìàíäè,
ÿê³ ïðàöþþòü ñï³ëüíî ç ³íøèìè ôàõ³âöÿìè òà
ìåäè÷íèìè ñïåö³àë³ñòàìè;
– Çàâäÿêè ï³äõîäó, îð³ºíòîâàíîìó íà ôóíêö³þ,
ÔÐÌ âèêîðèñòîâóº ìóëüòèìîäàëüíèé ï³äõ³ä, ùî
îõîïëþº øèðîêèé ñïåêòð ³íñòðóìåíò³â âòðó÷àí-
íÿ (÷àñòî íàäàþòüñÿ ³íøèìè ôàõ³âöÿìè ç ðåà-
á³ë³òàö³¿) ³ çàéìàºòüñÿ ìåíåäæìåíòîì óñ³õ çàõâî-
ðþâàíü ëþäèíè (ñòàí³â çäîðîâ’ÿ), îñê³ëüêè âîíà
ôîêóñóºòüñÿ íà çìåíøåíí³ ñòóïåíþ ïîðóøåíü ³
îáìåæåíü àêòèâíîñò³, ùîá ìàêñèìàëüíî ðîçøè-
ðèòè ìîæëèâó ó÷àñòü ïàö³ºíò³â;
– Îñê³ëüêè ÔÐÌ ´ðóíòóº ñâîþ ðîáîòó íà ôóíêö³-
îíóâàíí³, âîíà ìຠòðàíñâåðçàëüíó ðîëü äëÿ
³íøèõ ñïåö³àëüíîñòåé: âîíà ïåðåêðèâຠê³ëüêî ç
íèõ, ðîçä³ëÿþ÷è ÷àñòèíó ¿õ çíàíü, àëå âîíà òà-
êîæ ïîâí³ñòþ íåçàëåæíà â³ä óñ³õ ç íèõ, îñê³ëü-
êè âîíà çàñíîâàíà íà ³íøîìó îêðåìîìó îáñÿç³
çíàíü, ÿêèé òàêîæ º òðàíñâåðçàëüíèì äî ³íøèõ
ñïåö³àëüíîñòåé;
– ÔÐÌ çîñåðåäæåíà íà ïåðñîí³, à í³ íà õâîðîáàõ,
í³ íà çàêëàäàõ; ôàêòè÷íî, ÔÐÌ íå ò³ëüêè º
òðàíñâåðçàëüíîþ äî ñïåö³àëüíîñòåé, àëå ³ äî
çàêëàä³â, äå íàäàºòüñÿ äîïîìîãà, òà ë³êàð³
ÔÐÌ ïîâèíí³ çíàòè ö³ ð³çí³ ðåàëüíîñò³: îñîáè ç
îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà ç äîâãîòðè-
âàëèìè ñòàíàìè çäîðîâ’ÿ ôàêòè÷íî ïåðåì³ùó-
þòüñÿ âñåðåäèí³ íàö³îíàëüíèõ ñèñòåì îõîðîíè
çäîðîâ’ÿ ì³æ ð³çíèìè çàêëàäàìè äëÿ çäîáóòòÿ
íàéêðàùîãî ìîæëèâîãî ôóíêö³îíóâàííÿ òà
ó÷àñò³ ÷åðåç â³äïîâ³äíèé ïðîöåñ ðåàá³ë³òàö³¿.
Ìåòà ö³º¿ ãëàâè – äåòàëüíî îáãîâîðèòè âñ³ öåí-
òðàëüí³ ïðèíöèïè ìåäè÷íî¿ ñïåö³àëüíîñò³ ÔÐÌ, ùî
ðîáëÿòü ¿¿ óí³êàëüíîþ, ñïåöèô³÷íîþ ³ âàæëèâîþ â
ñó÷àñí³é òåíäåíö³¿ îõîðîíè çäîðîâ’ÿ, ÿêà âêëþ÷àº
ãîñòð³ ³ äîâãîòðèâàë³ ñòàíè çäîðîâ’ÿ, õàðàêòåðè-
çóºòüñÿ çá³ëüøåííÿì îáìåæåíü æèòòºä³ÿëüíîñò³,
62 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
âíàñë³äîê ïîë³ïøåííÿ âèæèâàííÿ ³ ïðîãðåñóþ÷îãî
ñòàð³ííÿ â ïîïóëÿö³ÿõ.
ϳäõ³ä ÔÐÌ, îð³ºíòîâàíèé íà îñîáó /
ôóíêö³îíóâàííÿ ïîð³âíÿíî ç ï³äõîäîì,
îð³ºíòîâàíèì íà õâîðîáó
ϳñëÿ ïåðøèõ ðîçòèí³â ³ ðîçóì³ííÿ àíàòî쳿 òà
ô³ç³îëî㳿, íàóêà â ñó÷àñí³é ìåäèöèí³ ïðîãðåñóâà-
ëà, ãëèáîêî âêîð³íþþ÷èñü ó çíàíí³ ñòðóêòóð ³
ôóíêö³é îðãàí³çìó: ö³ æîðñòê³ â³äíîñèíè ç ô³çè÷íîþ
ëþäèíîþ äîçâîëèëè ïîäîëàòè ìàéæå ìàã³÷í³ òðà-
äèö³¿, ÿê³ â óñí³é ôîðì³ ïåðåäàâàëèñÿ â³ä ìàéñòð³â
ïîñë³äîâíèêàì, ÿê³ êåðóâàëè îô³ö³éíîþ ìåäèöèíîþ
ç ñàìîãî ïî÷àòêó ³ñòîð³¿. Îòæå, ìåäèöèíà áóëà
îðãàí³çîâàíà, ãîëîâíèì ÷èíîì, íàâêîëî äèñöèïë³í,
ùî ìàëè â öåíòð³ óâàãè ñòðóêòóðè/ôóíêö³¿ îðãàí³ç-
ìó, òàê³, ÿê ñåðöå (êàðä³îëîã³ÿ), ëåãåí³ (ïíåâìîëî-
ã³ÿ), ñóãëîáè, ê³ñòêè ³ ì’ÿçè (îðòîïåä³ÿ), ìîçêîâ³ ³
íåðâîâî-ì’ÿçîâ³ ôóíêö³¿ (íåâðîëîã³ÿ), î÷³ (îôòàëü-
ìîëîã³ÿ). ²ñíóº ê³ëüêà âèíÿòê³â ³ç öüîãî çàãàëüíî-
ãî ïðàâèëà, ç îáëàñòÿìè, ÿê³ ìîæíà ââàæàòè
“òðàíñâåðçàëüíèìè” äëÿ ïîïåðåäí³õ “âåðòèêàëü-
íèõ” – òàê, ÿê çàãàëüíà ìåäèöèíà, ïåä³àòð³ÿ òà
ãåð³àòð³ÿ. Öåé ï³äõ³ä, ùî ´ðóíòóºòüñÿ íà îðãàíàõ,
ïðèçâ³â äî êëàñè÷íî¿ “á³îìåäè÷íî¿ ìîäåë³” ë³êóâàí-
íÿ, äå ïîøóê åò³îëî㳿 òà ïàòîëîã³÷íî¿ àíàòî쳿/
ô³ç³îëî㳿 çàõâîðþâàííÿ ââàæàºòüñÿ øëÿõîì äî
âèáîðó åôåêòèâíîãî ë³êóâàííÿ, óñóíåííÿ ïðè÷èíè
õâîðîáè òà âèë³êîâóâàííÿ ïàö³ºíòà (Ìàëþíîê 1).
˳êàð³ âèðîñòàþòü ç óðàõóâàííÿì ö³º¿ ìîäåë³: íà-
ñïðàâä³, ï³ñëÿ îñíîâíèõ ïðåäìåò³â ïåðøèõ ðîê³â
íàâ÷àííÿ, «ïàòîëîã³÷íà àíàòîì³ÿ» º îäíèì ç ïåð-
øèõ ïðåäìåò³â, ÿê³ çíàéîìëÿòü ñòóäåíò³â-ìåäèê³â
ç êë³í³÷íèì ñâ³òîì.
ÔÐÌ íàðîäèëàñü ³íàêøå, òà íå íàâêîëî êîíê-
ðåòíî¿ ñòðóêòóðè / ôóíêö³¿ îðãàí³çìó: íàñïðàâä³
ïðîãðåñ Ìåäèöèíè òà Õ³ðóð㳿 äîçâîëèâ âñå á³ëüøå
³ á³ëüøå âèæèâàòè ãîñòðèì ïàö³ºíòàì (íàïð. ï³ñëÿ
âàæêèõ ïîðóøåíü âíàñë³äîê íåùàñíèõ âèïàäê³â,
âîºííèõ òðàâì òà/àáî ³íôåêö³éíèõ õâîðîá – ÿê ïîë³-
î쳺ë³ò), ³ öå âèìàãàëî îñîáëèâî¿ óâàãè äî öèõ
íàñë³äê³â. Îòæå, óâàãà ÔÐÌ ç ñàìîãî ïî÷àòêó ñòî-
ñóâàëàñü äîñÿãíåííÿ íàéêðàùîãî ìîæëèâîãî “ôóí-
êö³îíóâàííÿ” ïðè äîâãîòðèâàëîìó ñòàí³ çäîðîâ’ÿ.
³äðàçó áóëî ö³ëêîì çðîçóì³ëî, ùî êëàñè÷íà á³î-
ìåäè÷íà ìîäåëü íå ìîæå áóòè çàñòîñîâàíà â
Ìàëþíîê 1. ϳäõ³ä, ùî áàçóºòüñÿ íà îðãàíàõ, êëàñè÷íî¿ «á³î-
ìåäè÷íî¿ ìîäåë³» â ìåäèöèí³
¹2(2) *2018

Ìàëþíîê 2. Ìîäåëü ̳æíàðîäíî¿ êëàñèô³êàö³¿ ïîðóøåíü, îá-
ìåæåíü æèòòºä³ÿëüíîñò³ òà ñîö³àëüíî¿ íåäîñòàòíîñò³
(ÌÊÏ)1
Ìàëþíîê 3. Ìîäåëü ̳æíàðîäíî¿ êëàñèô³êàö³¿ ôóíêö³îíóâàí-
íÿ, îáìåæåíü æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ)2.
ÔÐÌ, àëå ïðîéøëè äåñÿòèë³òòÿ, ïåðø í³æ öÿ êîí-
öåïö³ÿ ôóíêö³îíóâàííÿ ñòàëà ïîâí³ñòþ çðîçóì³ëîþ.
Ïðîðèâ ñòàâñÿ ï³ñëÿ ïðèéíÿòòÿ ̳æíàðîäíî¿ êëà-
ñèô³êàö³¿ ïîðóøåíü, îáìåæåíü æèòòºä³ÿëüíîñò³ òà
ñîö³àëüíî¿ íåäîñòàòíîñò³ (ÌÊÏ)1 (Ìàëþíîê 2), à
ñë³äîì çà öèì – ̳æíàðîäíî¿ êëàñèô³êàö³¿ ôóíêö³-
îíóâàííÿ, îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ
(ÌÊÔ)2 (Ìàëþíîê 3). Ó òîé æå ÷àñ áóëî ðîçðîá-
ëåíà “á³î-ïñèõî-ñîö³àëüíà ìîäåëü” ë³êóâàííÿ3,4, äå
òåðàï³ÿ ñïðÿìîâàíà íà äîïîìîãó îñîá³. Ôàêòè÷íî,
ç ñàìîãî ïî÷àòêó áóëî ÿñíî, ùî ÿäðîì ÔÐÌ º íå
ò³ëüêè ñòðóêòóðà/ôóíêö³ÿ îðãàí³çìó, àëå îñîáà òà
ëþäñüêà ³ñòîòà â ö³ëîìó, âêëþ÷àþ÷è éîãî ïñèõî-
ëîã³þ ³ ìîòèâàö³þ (çâàí³ ñüîãîäí³ «îñîáèñòèìè
ôàêòîðàìè») ³ ñîö³àëüíå ñåðåäîâèùå (çâàí³ ñüî-
ãîäí³ «ó÷àñòü» ³ «ôàêòîðè ñåðåäîâèùà»).
Ôàêòè÷íà äîâ³äêîâà ñèñòåìà ñïåö³àëüíîñò³,
ÌÊÔ, âêëþ÷ຠâñ³ ö³ àñïåêòè (Ìàëþíîê 3). Ö³êà-
âî ïîäèâèòèñÿ íà öþ ñõåìó ³ çðîçóì³òè, äå çíàõî-
äèòüñÿ íàøà ñïåö³àëüí³ñòü “ùî ´ðóíòóºòüñÿ íà
ôóíêö³îíóâàíí³”, ç ¿¿ øèðîêèì ï³äõîäîì äî îñîáè,
ó ïîð³âíÿíí³ ç êëàñè÷íèìè ñïåö³àëüíîñòÿìè, “ùî
´ðóíòóþòüñÿ íà îðãàíàõ”, ç ¿õ ï³äõîäàìè, ùî îð³º-
íòóþòüñÿ íà õâîðîáó. ³äïîâ³äíî äî “á³îìåäè÷íî¿
ìîäåë³”, îñòàíí³ çîñåðåäæåí³ ãîëîâíèì ÷èíîì íà
çàõâîðþâàíí³, à òàêîæ íà ñòðóêòóðàõ òà ôóíêö³ÿõ
îðãàí³çìó (Ìàëþíîê 4). Íàòîì³ñòü ÔÐÌ çîñåðåä-
æóºòüñÿ â ö³ëîìó íà ôóíêö³îíóâàíí³ òà îáìåæåíí³
æèòòºä³ÿëüíîñò³ (ùî íàñïðàâä³ º âñ³ºþ îñîáîþ);
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 3 – ÏÅÐÂÈÍÍÀ ÌÅÄÈ×ÍÀ ÑÏÅÖ²ÀËÜͲÑÒÜ: ÎÑÍÎÂÈ ÔÐÌ
Ìàëþíîê 4. ³äïîâ³äíî äî «á³îìåäè÷íî¿ ìîäåë³», êëàñè÷í³ ìå-
äè÷í³ ñïåö³àëüíîñò³, ùî «´ðóíòóþòüñÿ íà îðãàíàõ» ïåðåâàæ-
íî ïðèä³ëÿþòü óâàãó õâîðîá³, òàê æå, ÿê ñòðóêòóðàì òà ôóí-
êö³ÿì îðãàí³çìó.
Ìàëþíîê 5. Ñïåö³àëüí³ñòü ÔÐÌ, ÿêà «´ðóíòóºòüñÿ íà ôóíêö³-
îíóâàíí³» ïåðåâàæíî ïðèä³ëÿº óâàãó íà ôóíêö³îíóâàííþ îáìå-
æåííÿì æèòòºä³ÿëüíîñò³ (ôàêòè÷íî öå º ö³ëà îñîáà);
êë³í³÷íà ðîáîòà ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè ñïå-
öèô³÷íî çîñåðåäæóºòüñÿ íà çìåíøåíí³ «îáìåæåíü àêòèâ-
íîñò³» òà ïîë³ïøåíí³ «ïîðóøåíü», â òîé æå ÷àñ çâåðòàþ÷èñü
äî «îáìåæåíü ó÷àñò³» íà ì³êðî-ð³âí³ (ïåðñîíà), â òîé æå ÷àñ
çâåðíåííÿ äî ìåçî- òà ìàêðî-ð³âí³â òàêîæ º ìîæëèâèì ç åêñ-
ïåðòíîþ äîïîìîãîþ ë³êàð³â ÔÐÌ òèì, õòî ïðàöþº íàä ñóñ-
ï³ëüñòâîì â ö³ëîìó, âêëþ÷àþ÷è îñâ³òÿí, ïîë³òèê³â òà ³íøèõ
ëþäåé, ùî óõâàëþþòü ð³øåííÿ. Äëÿ òîãî, ùîá öå ðîáèòè, ë³êà-
ðþ íåîáõ³äíî ÔÐÌ â³äì³ííî çíàòè ìåäè÷íèé ä³àãíîç («ñòàí
çäîðîâ’ÿ» àáî «õâîðîáó») òà ì³öíî êîîðäèíóâàòèñü ç «êîíòåê-
ñòóàëüíèìè ôàêòîðàìè» («îñîáèñò³» òà «ñåðåäîâèùà»).
ʳíöåâîþ ö³ëëþ º ìàêñèìàëüíî ìîæëèâà «ó÷àñòü» äëÿ îñîáè.
êë³í³÷íà ðîáîòà ÔÐÌ (Ìàëþíîê 5) ñïåö³àëüíî
ôîêóñóºòüñÿ íà çìåíøåíí³ “îáìåæåíü àêòèâíîñò³”
òà ïîë³ïøåíí³ íàñë³äê³â «ïîðóøåíü», âîäíî÷àñ ðîç-
ãëÿäàþ÷è òàêîæ “îáìåæåííÿ ó÷àñò³” íà ì³êðîð³âí³
(ïåðñîíàëüíîìó), âîäíî÷àñ ðîçãëÿäàþ÷è ìåçî- òà
ìàêðîð³âí³ çà åêñïåðòíîþ äîïîìîãîþ ë³êàð³â ÔÐÌ
òèì, õòî ïðàöþº íà ñóñï³ëüñòâ³ â ö³ëîìó, âêëþ÷à-
63
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
þ÷è îñâ³òÿí, ïîë³òèê³â òà ³íøèõ îñ³á, ùî ñõâàëþ-
þòü ð³øåííÿ. Ïðè öüîìó ë³êàð ÔÐÌ îáîâ’ÿçêîâî
ïîâèíåí çíàòè ìåäè÷íèé ä³àãíîç («ñòàí çäîðîâ’ÿ»
³ «õâîðîáó») ³ ù³ëüíî âçàºìîä³ÿòè ç «êîíòåêñòóàëü-
íèìè ôàêòîðàìè» («îñîáèñòèì» ³ «ñåðåäîâèù-
íèì»). ʳíöåâîþ ìåòîþ äëÿ ëþäèíè º ¿¿ ìàêñè-
ìàëüíî ìîæëèâà «ó÷àñòü».
Íèæ÷åçàçíà÷åí³ ïîçèö³¿ â ö³ëîìó, â³äð³çíÿþòü
ïàö³ºíò-îð³ºíòîâàíèé ï³äõ³ä ÔÐÌ â³ä îð³ºíòîâàíî-
ãî íà õâîðîáó ó ñïåö³àëüíîñòåé, ùî ´ðóíòóþòüñÿ
íà îðãàíí³é ïàòîëî㳿:
– êîìïëåêñíèé á³î-ïñèõîñîö³àëüíèé ï³äõ³ä äî
ñòàí³â çäîðîâ’ÿ äëÿ âðàõóâàííÿ óñ³õ àñïåêò³â
ôóíêö³îíóâàííÿ;
– ïðàêòè÷íèé ìåäè÷íèé ï³äõ³ä äî ïîðóøåíü òà
îáìåæåíü àêòèâíîñò³, ç îñíîâíîþ ³ ê³íöåâîþ
ö³ëëþ – ïîçèòèâíîìó âïëèâ³ ³, íàðåøò³, ïîë-
³ïøåíí³ ó÷àñò³;
– âðàõóâàííÿ êîíòåêñòóàëüíèõ ôàêòîð³â ïàö³ºíò³â
ïðè ïëàíóâàíí³ ðåàá³ë³òàö³éíèõ ïðîãðàì; â òåð-
ì³íîëî㳿 ÌÊÔ âîíè ñëóãóþòü «ñïðèÿòëèâèìè
÷èííèêàìè» òà/àáî «áàð’ºðàìè» äëÿ äîñÿãíåí-
íÿ íàéêðàùîãî ôóíêö³îíóâàííÿ: ïñèõîëîã³÷í³,
êîãí³òèâí³, ìîòèâàö³éí³ òà åêîíîì³÷í³ ³íäèâ³äó-
àëüí³ ÷èííèêè, à òàêîæ ôàêòîðè ñåðåäîâèùà
(âêëþ÷àþ÷è äîãëÿäà÷³â, ãåîãðàô³÷íå ðîçòàøó-
âàííÿ, çàêîíîäàâñòâî, çàãàëüíèé åêîíîì³÷íèé
ð³âåíü êðà¿íè...) ìàþòü âèð³øàëüíå çíà÷åííÿ
äëÿ ðåçóëüòàòó;
– çàáåçïå÷åííÿ ôîêóñó íà îïòèìàëüí³é ó÷àñò³ ïà-
ö³ºíòà º âèñîêî î÷³êóâàíîþ ðåàá³ë³òàö³éíîþ ìå-
òîþ ïàö³ºíò³â, ³, ïî ñóò³, ¿¿ ê³íöåâèì ðåçóëüòàòîì;
– îñíîâíèé ñòàí çäîðîâ’ÿ – öå êîíòåêñò ïðîãðà-
ìè ÔÐÌ. Íàäàííÿ ïîñëóã äëÿ òèõ, õòî ìàº
øâèäêî ïðîãðåñóþ÷ó õâîðîáó, ìîæå ñèëüíî
â³äð³çíÿòèñü â³ä ïîñëóã äëÿ òèõ, õòî ìຠõðîí³-
÷íèé, ïîâ³ëüíî ïðîãðåñóþ÷èé ñòàí. Çíàííÿ ä³àã-
íîçó äîçâîëÿº ë³êàðþ ÔÐÌ çàáåçïå÷èòè îïòè-
ìàëüíå ë³êóâàííÿ, ïåðåäáà÷àòè ïîòåíö³éí³
óñêëàäíåííÿ òà ñóïóòí³ ñòàíè, ñïîâ³ëüíþâàòè
ïîã³ðøåííÿ (äå äîðå÷íî) òà ñêëàäàòè ïðîãíîç,
ÿêèé ìîæå âêëþ÷àòè îáãîâîðåííÿ ïðî ê³íåöü
æèòòÿ;
– âòðó÷àííÿ ÔÐÌ º ð³çíèìè â óñüîìó ñâ³ò³, â³äïî-
â³äíî äî ³ñíóþ÷èõ êîíòåêñòîâèõ ôàêòîð³â òà
ð³âíÿ ó÷àñò³, ÿêèé º íåîáõ³äíèì òà äîçâîëåíèì
â êîæíîìó êîíêðåòíîìó ñóñï³ëüñòâ³5,6.
²íøå ñëîâî, ùî øèðîêî âèêîðèñòîâóºòüñÿ
â³äíîñíî äî ÔÐÌ, º «õîë³çì», äëÿ ñòâåðäæåííÿ ïðî
òå, ùî ÔÐÌ çîñåðåäæåíà íà âñ³º¿ ëþäèí³. Öå ñëî-
âî ³äåàëüíî ï³äêðåñëþº ñïåö³àëüí³ñòü, ùî îð³ºíòî-
âàíà íà “ôóíêö³îíóâàííÿ” òà “îáìåæåííÿ æèòòºä³-
ÿëüíîñò³” (ÿê³ çà âèçíà÷åííÿì º “õîë³ñòè÷íèìè”).
Ó öüîìó êîíòåêñò³ çíà÷åííÿ òåðì³íó «õîë³çì» ïî-
âí³ñòþ â³äð³çíÿºòüñÿ â³ä çíà÷åííÿ â àëüòåðíàòèâ-
64 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
íèõ / äîäàòêîâèõ ïðàêòèêàõ, ³ âîíî íå âèêîðèñòî-
âóºòüñÿ äëÿ îá´ðóíòóâàííÿ íàóêîâî íåäîâåäåíèõ
ìåòîä³â ë³êóâàííÿ: ÔÐÌ íàñïðàâä³ º ïåðâèííîþ
ìåäè÷íîþ ñïåö³àëüí³ñòþ, çàñíîâàíîþ âèêëþ÷íî íà
äîêàçàõ.
Çâàæàþ÷è íà òåïåð³øí³ õàðàêòåðèñòèêè ÔÐÌ,
ÿê ñïåö³àëüíîñò³ ç òðàíñâåðçàëüíèì çíàííÿì (îð³-
ºíòîâàíî¿ íà îñîáó), àëå ÿê³ ìîæóòü áóòè âåðòè-
êàëüíî çàñòîñîâàí³ âñåðåäèí³ ³íøèõ ñïåö³àëüíîñ-
òåé (îð³ºíòîâàíèõ íà õâîðîáè) ³ñíóº áàãàòî
ìîæëèâèõ âàð³àíò³â êë³í³÷íèõ ï³äõîä³â. Ìè ìîãëè
á ðîçãëÿíóòè ¿õ ç îãëÿäó íà äâ³ ìîæëèâ³ êðàéíîù³:
– “çàãàëüíèé ë³êàð ÔÐÌ” (çà àíàëî㳺þ ç “ë³êà-
ðåì çàãàëüíî¿ ïðàêòèêè”), ÿêèé ïîâèíåí ìàòè
äóæå äîáð³ çíàííÿ óñ³õ ñòàí³â çäîðîâ’ÿ, ùî ïî-
òðåáóþòü ï³äõîäó ÔÐÌ; â³í / âîíà ïîâèíí³ áóòè
çäàòíèìè âåñòè ïàö³ºíò³â ç óñ³ìà ïàòîëîã³ÿìè.
Öÿ ìîäåëü â îñíîâíîìó ïîøèðåíà â ãîñòðèõ
â³ää³ëåííÿõ òà â ï³äãîñòð³é ñòàö³îíàðí³é ïðàê-
òèö³ ó çàãàëüíèõ â³ää³ëåííÿõ ÔÐÌ (ïåðâèííà
ðåàá³ë³òàö³éíà äîïîìîãà). Ïåðåâàãîþ â öüîìó
âèïàäêó áóäå ìîæëèâ³ñòü ìåíåäæìåíòó â
ÿêîñò³ ºäèíîãî ìåäè÷íîãî ñïåö³àë³ñòà ç ìóëü-
òè-ïðîôåñ³éíîþ êîìàíäîþ, ùî ïðàöþº ñï³ëüíî
ç ³íøèìè äèñöèïë³íàìè, ïðàêòè÷íî óñ³õ
ïàö³ºíò³â, òà ìîæëèâ³ñòü âèêîíóâàòè ñîðòóâàí-
íÿ, äëÿ ñêåðóâàííÿ íàéá³ëüø ñêëàäíèõ ïàö³ºíò³â
äî âòîðèííî¿ / òðåòèííî¿ äîïîìîãè; íåäîë³êîì º
ìîæëèâà âòðàòà ñïåöèô³÷íîñò³ (âåëèêèé ÷àñ
äëÿ ë³êóâàííÿ çàõâîðþâàííÿ ³ íåäîñòàòí³é ÷àñ
äëÿ çîñåðåäæåííÿ íà ðåàá³ë³òàö³¿) òà âòðàòà
ãëèáîêèõ çíàíü â ñïåöèô³÷íèõ îáëàñòÿõ.
– ³ “ñïåö³àë³çîâàíèé ë³êàð ÔÐÌ”: ó öüîìó âèïàä-
êó êë³í³öèñò ñòຠâèñîêèì ñïåö³àë³ñòîì òàêîæ ³
â îñíîâí³é “îðãàíí³é” ñïåö³àëüíîñò³, âòðà÷àþ-
÷è ïåâí³ çàãàëüí³ êîìïåòåíòíîñò³ òà çîñåðåäæó-
þ÷èñü ãîëîâíèì ÷èíîì íà ìåäè÷í³é ä³àãíîñòèö³,
îáñòåæåíí³, ë³êóâàíí³ òà ðåàá³ë³òàö³¿ õâîðèõ íà
ñïåöèô³÷í³ çàõâîðþâàííÿ. Öå íàé÷àñò³øå ðîç-
ïîâñþäæóºòüñÿ íà òðåòèíí³ â³ää³ëåííÿ ÔÐÌ,
ï³äãîñòð³ â³ää³ëåííÿ ÔÐÌ íàóêîâèõ òà óí³âåð-
ñèòåòñüêèõ çàêëàä³â, àëå òàêîæ â äåÿêèõ àìáó-
ëàòîðíèõ çàêëàäàõ. Ïåðåâàãîþ â äàíîìó âèïàä-
êó º âèñîêà ñïåöèô³÷í³ñòü ðîáîòè, ëåãê³ñòü
êîíòàêò³â ç “îðãàííèìè” ñïåö³àë³ñòàìè (â
íàéá³ëüø ïîøèðåíèõ âèïàäêàõ ³íîä³ íàâ³òü ìîæ-
ëèâî çíèçèòè ¿õ êîíêðåòíèé âïëèâ), ãëèáîê³ ñïå-
öèô³÷í³ çíàííÿ; íåäîë³êîì º çîñåðåäæåí³ñòü íà
ïåâíèõ çíàííÿõ, ÿê³ äóæå íàãàäóþòü çíàííÿ
“îðãàííèõ” ôàõ³âö³â.
̳æ öèìè äâîìà êðàéíîùàìè ñüîãîäí³ â ïðàê-
òèö³ ÔÐÌ ³ñíóþòü âñ³ ìîæëèâîñò³, ³ ôàõ³âö³ ÔÐÌ
ïðîõîäÿòü ï³äãîòîâêó ÿê äëÿ öèõ êðàéíîù³â, òàê ³
äëÿ âñ³õ ³íøèõ êë³í³÷íèõ ñèòóàö³é.
¹2(2) *2018

ijàãíîñòè÷í³ îáîâ’ÿçêè ë³êàð³â ÔÐÌ
ßê çàçíà÷àëîñÿ âèùå, â êîíòåêñò³ ÌÊÔ ðåàá³-
ë³òàö³ÿ – öå ñòðàòåã³ÿ îõîðîíè çäîðîâ’ÿ, ÿêà ñïðÿ-
ìîâàíà íà óìîæëèâëåííÿ îñ³á ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ äîñÿãòè îïòèìàëüíîãî ôóíêö³îíó-
âàííÿ â ïðîöåñ³ âçàºìî䳿 ç ¿õ ñåðåäîâèùåì7. Öÿ
ïåðâèííà ôóíêö³ÿ äîñÿãàºòüñÿ çà ðàõóíîê ñàìîãî
ïðîöåñó ðåàá³ë³òàö³¿, àëå, ïî-ïåðøå, âîíà áàçóºòü-
ñÿ íà ñïåöèô³÷íîìó ìåäè÷íîìó ä³àãíîç³. Öå íàäàº
“ìåæ³” âòðó÷àííÿì ÔÐÌ, âèçíà÷àþ÷è ìåäè÷íèé
ïðîãíîç ³, â³äïîâ³äíî, áàãàòî î÷³êóâàíü ïàö³ºíòà ç
ìåäè÷íî¿ ïåðñïåêòèâè. Öÿ ïåðñïåêòèâà çàáåçïå÷óº
ñòàá³ëüíó îñíîâó, íàâêîëî ÿêî¿ ìîæóòü áóòè ðîç-
ðîáëåí³ âñ³ ³íø³ êîìïîíåíòè ïðîãðàìè ÔÐÌ. Ôàê-
òè÷íî, ìåäè÷íèé ä³àãíîç ïðîãíîçóº ðÿä ìîæëèâèõ
çàëèøêîâèõ ïîðóøåíü, îáìåæåíü àêòèâíîñò³ òà,
òàêîæ (ìåíøîþ ì³ðîþ) îáìåæåíü ìîæëèâîñò³
ó÷àñò³. Òå, ùî ìåäè÷íèé ä³àãíîç íå âèçíà÷ຠ– öå
ð³âåíü öèõ ïîðóøåíü, âíóòð³øí³õ òà çîâí³øí³õ îá-
ìåæåíü: ôàêòè÷íî âîíè áóäóòü ðåçóëüòàòîì ïðî-
öåñó ðåàá³ë³òàö³¿ ðàçîì ç îñîáèñòèìè ôàêòîðàìè ³
ôàêòîðàìè ñåðåäîâèùà.
Áåç òî÷íîãî ìåäè÷íîãî ä³àãíîçó íåìîæëèâî
ðîçïî÷àòè òà íàëåæíèì ÷èíîì ïëàíóâàòè ïðîãðà-
ìó ÔÐÌ, ÿê äóæå êîðîòêî÷àñíó, êîðîòêî÷àñíó, òàê
³ äîâãîòðèâàëó. Ìåäè÷íèé ä³àãíîç âèçíà÷ຠòàêîæ
ñòèëü ñï³ëêóâàííÿ ç ïàö³ºíòîì òà äîìîâëåíîñò³
ùîäî äîñÿãíåííÿ äîñÿæíèõ ö³ëåé. Íà ïî÷àòêó ïðî-
öåñó ðåàá³ë³òàö³¿ ïàö³ºíòîâ³ òà éîãî/¿¿ ðîäèí³ / íà-
äàâà÷àì äîïîìîãè íåîáõ³äíî ïðèéíÿòè éîãî íîâèé
“ñòàòóñ”. Ïîò³ì â³í áóäå âçàºìîä³ÿòè ç éîãî ÷è ¿¿
îñîáèñòèìè ôàêòîðàìè òà ôàêòîðàìè ñåðåäîâèùà,
äëÿ âñòàíîâëåííÿ òà âèçíà÷åííÿ ðåçóëüòàò³â ðåà-
á³ë³òàö³éíîãî ïðîöåñó.
Îòæå, ë³êàð³ ÔÐÌ ìàþòü âåëèêó ìåäè÷íó ä³àã-
íîñòè÷íó â³äïîâ³äàëüí³ñòü. Ó äåÿêèõ êë³í³÷íèõ
ñèòóàö³ÿõ, çàçâè÷àé, êîëè ïîã³ðøåííÿ ñòàíó ïàö³º-
íòà º ì’ÿêèì (íàïð. ï³ñëÿ “êîíñåðâàòèâíîãî” ë³êó-
âàííÿ â îðòîïåäè÷í³é òà / àáî ñïîðòèâí³é ìåäèöèí³),
ë³êàð ÔÐÌ º ïåðøèì ìåäè÷íèì ïðàö³âíèêîì, ÿêèé
ñòåæèòü çà ïàö³ºíòîì ³ âñòàíîâëþº ä³àãíîç. Ó öèõ
âèïàäêàõ ë³êàð ÔÐÌ ãðຠïåðâèííó ðîëü â îö³íþ-
âàíí³ ïàö³ºíò³â äëÿ ìîæëèâèõ àëüòåðíàòèâíèõ ìå-
òîä³â ë³êóâàííÿ òà/àáî ñêåðóâàííÿ äëÿ á³ëüø ñïå-
öèô³÷íî¿ ä³àãíîñòèêè ³íøèìè ñïåö³àë³ñòàìè. Â
³íøèõ êë³í³÷íèõ ñèòóàö³ÿõ, çàçâè÷àé, ó â³ää³ëåííÿõ
ï³äãîñòðî¿ äîïîìîãè, ë³êàð³ ÔÐÌ âèêëèêàþòüñÿ
ï³ñëÿ äîëó÷åííÿ ³íøèõ ñïåö³àë³ñò³â. Ó òàêèõ ñèòó-
àö³ÿõ ðîëü ë³êàðÿ ÔÐÌ ïîëÿãຠó ïåðåâ³ðö³ òà
ï³äòâåðäæåíí³ ïåðâèííîãî ìåäè÷íîãî ä³àãíîçó ïà-
ö³ºíòà òà âèÿâëåíí³ ó íüîãî áóäü-ÿêèõ ñóïóòí³õ
çàõâîðþâàíü òà âæå â³äîìèõ ïîðóøåíü òà îáìå-
æåíü àêòèâíîñò³. ²íø³ ìåäè÷í³ ñïåö³àë³ñòè ³íîä³
ïî÷óâàþòü ñåáå íåçðó÷íî ïðè ¿õ îö³íþâàíí³,
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 3 – ÏÅÐÂÈÍÍÀ ÌÅÄÈ×ÍÀ ÑÏÅÖ²ÀËÜͲÑÒÜ: ÎÑÍÎÂÈ ÔÐÌ
îñê³ëüêè öå çíàõîäèòüñÿ “çà ìåæàìè ¿õ êîìïåòåíö³é,
ñïåöèô³÷íèõ äëÿ ñïåö³àëüíîñò³”. Ïîäàëüøå ñïîñ-
òåðåæåííÿ ïàö³ºíòà â ñåðåäíüî- òà äîâãîñòðîêîâ³é
ïåðñïåêòèâ³ ³íîä³ äîçâîëÿº óòî÷íèòè ìåäè÷íèé
ä³àãíîç, êîëè ïåðåá³ã çàõâîðþâàííÿ íå â³äïîâ³äàº
éîãî çâè÷àéíîìó î÷³êóâàíîìó ïàòåðíó. Âèíÿòîê ³ç
öüîãî çàãàëüíîãî ïðàâèëà ïîëÿãຠâ òîìó, ùî ³íîä³
íåìîæëèâî îäðàçó æ âñòàíîâèòè äîñòîâ³ðíèé ä³àã-
íîç ³ ë³êóâàííÿ ìîæå áóòè çàïðîïîíîâàíî äëÿ òîãî,
ùîá ç’ÿñóâàòè öå äàë³ (ä³àãíîç «ex adjuvantibus»).
Êð³ì çàãàëüíîãî ìåäè÷íîãî ä³àãíîçó, ë³êàð
ÔÐÌ íåñå îñîáëèâó â³äïîâ³äàëüí³ñòü çà ôóíêö³î-
íàëüíå îö³íþâàííÿ ïàö³ºíò³â ïåðåä ïî÷àòêîì ïðî-
öåñó ÔÐÌ. Öå íàñàìïåðåä ñïðÿìîâàíî íà âèçíà-
÷åííÿ ïîðóøåíü òà îáìåæåíü àêòèâíîñò³,
âèì³ðþâàííÿ ¿õ ð³âíÿ òà, â³äïîâ³äíî, âèçíà÷åííÿ
ö³ëåé ïðîãðàìè ÔÐÌ äëÿ äîñÿãíåííÿ íàéêðàùî¿
³íäèâ³äóàëüíî¿ ó÷àñò³. Êð³ì òîãî, ë³êàð³ ÔÐÌ ìà-
þòü êîìïåòåíòíîñò³ ç âèÿâëåííÿ çíà÷åííÿ çàõâî-
ðþâàííÿ àáî îáìåæåííÿ æèòòºä³ÿëüíîñò³ äëÿ îê-
ðåìîãî ïàö³ºíòà, âïëèâó öüîãî íà ¿õ ïî÷óòòÿ
ïåðñîíàëüíî¿ ³äåíòè÷íîñò³ ³ âèíèêàþ÷î¿ â ðåçóëü-
òàò³ åìîö³éíî¿ ðåàêö³¿. ×àñòèíè ôóíêö³îíàëüíîãî
îö³íþâàííÿ òàêîæ ìîæóòü áóòè çðîáëåí³ ³íøèìè
ôàõ³âöÿìè ç ðåàá³ë³òàö³¿, àëå âàæëèâî, ùî ë³êàð³
ÔÐÌ âèêîíóþòü ¿¿ äëÿ âñ³õ äîìåí³â ñòðóêòóð/
ôóíêö³é îðãàí³çìó òà àêòèâíîñòåé, òîä³ ÿê ³íø³ çî-
ñåðåäæóþòüñÿ ëèøå íà ¿õ ñïåöèô³÷íèõ êîìïåòåí-
òíîñòÿõ. ˳êàð³ ÔÐÌ ï³äòðèìóþòü, òàêèì ÷èíîì,
á³ëüø øèðîêó ïåðñïåêòèâó, ÿêà äîçâîëÿº âèçíà÷è-
òè ó ñï³âïðàö³ ç ³íøèìè ôàõ³âöÿìè ðåàá³ë³òàö³¿ ïð³î-
ðèòåòè ³ òèì÷àñîâ³ òåðì³íè äëÿ ð³çíèõ âòðó÷àíü.
Êð³ì òîãî, ôóíêö³îíàëüíå îö³íþâàííÿ – öå ÷àñòêî-
âå ïåðåêðèòòÿ êîìïåòåíòíîñòåé ð³çíèõ ôàõ³âö³â ç
ðåàá³ë³òàö³¿, ùî º çàãàëüíèì òëîì äëÿ ä³àëîãó, âçàº-
ìî䳿 òà ïîáóäîâè êîìàíäè. Ïðîòå, òàêîæ ó êî-
ìàíäí³é ïåðñïåêòèâ³, â³äïîâ³äàëüí³ñòü çà ôóíêö³î-
íàëüíå îö³íþâàííÿ, çðåøòîþ, ëåæèòü íà ïëå÷àõ
ë³êàð³â ÔÐÌ.
Ó ö³é ôóíêö³îíàëüí³é ïåðñïåêòèâ³ ³ñíóþòü äåÿê³
ä³àãíîñòè÷í³ ³íñòðóìåíòè, ùî º ñïåöèô³÷íèìè äëÿ
ÔÐÌ ³ øèðîêî ðîçðîáëåí³ â ðàìêàõ ñïåö³àëüíîñò³,
íàïð. îïèòóâàëüíèêè ç îáìåæåíü æèòòºä³ÿëüíîñò³
òà ÿêîñò³ æèòòÿ, à òàêîæ ñèñòåìè àíàë³çó ðóõó,
åëåêòðîä³àãíîñòè÷í³ òà óëüòðàçâóêîâ³ ³íñòðóìåí-
òè òîùî.
Êð³ì òîãî, ë³êàð³ ÔÐÌ áóëè ïåðøèìè, õòî âèç-
íàâ âàæëèâ³ñòü ÌÊÔ äëÿ ïîäàëüøîãî ðîçâèòêó
ðåàá³ë³òàö³¿, êðàùîãî ³íôîðìóâàííÿ â ñèñòåì³
îõîðîíè çäîðîâ’ÿ òà ñòèìóëþâàííÿ äîñë³äæåíü ç
çàãàëüíîþ ìåòîþ äîñÿãíåííÿ îïòèìàëüíîãî ôóí-
êö³îíóâàííÿ òà ì³í³ì³çàö³¿ îáìåæåíü æèòòºä³ÿëü-
íîñò³ ÿê îñ³á, òàê ³ çàãàëüíèõ àñïåêò³â îõîðîíè çäî-
ðîâ’ÿ 8-10.
65
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Ìóëüòèìîäàëüíèé ï³äõ³ä ÔÐÌ
³ ìåíåäæìåíò ìíîæèííèõ õâîðîá
ÔÐÌ îõîïëþº øèðîêèé ñïåêòð ðîçëàä³â ³ âêëþ-
÷ຠíàñë³äêè òðàâì, õ³ðóðã³÷íèõ âòðó÷àíü, çàõâî-
ðþâàíü òà âðîäæåíèõ ñòàí³â. Öå ð³çêî â³äð³çíÿºòü-
ñÿ â³ä/ç ³íøèõ ìåäè÷íèõ ñïåö³àëüíîñòåé, ùî
çàéìàþòüñÿ ë³êóâàííÿì îðãàí³â àáî ñèñòåì îðãàí³â
(íàïð. êàðä³îëîã³ÿ, íåôðîëîã³ÿ, äåðìàòîëîã³ÿ), ñïå-
öèô³÷íèõ â³êîâèõ ãðóï (íàïð. ïåä³àòð³ÿ, ãåð³àòð³ÿ),
àáî ÿê³ çàñòîñîâóþòü ïåâíèé íàâè÷îê àáî òåõí³÷-
íå îáëàäíàííÿ (íàïð. õ³ðóðã³ÿ, ðàä³îëîã³ÿ, ðàä³îòå-
ðàï³ÿ).
Òîìó ÔÐÌ çàçâè÷àé ðîçãëÿäàºòüñÿ ÿê “ãîðèçîí-
òàëüíà ñïåö³àëüí³ñòü”. Á³ëüø òîãî, ÔÐÌ íå çîñå-
ðåäæåíà ïåðâèííî, íà ïðîô³ëàêòèö³ àáî ë³êóâàíí³
õâîðîáè, ÿê òàêî¿, àëå çîñåðåäæåíà íà ¿¿ íàñë³äêàõ
ç òî÷êè çîðó îáìåæåíü àêòèâíîñò³ òà îáìåæåíü
ìîæëèâîñò³ ó÷àñò³. Çàïîá³ãàííÿ òà çìåíøåííÿ
îáìåæåíü àêòèâíîñò³ òà îïòèì³çàö³ÿ ó÷àñò³ º ÿä-
ðîì ÔÐÌ.
ßê íàñë³äîê, ÔÐÌ ïðèéíÿëà ïàö³ºíòî-öåíòðè÷-
íèé ï³äõ³ä, ÿêèé òàêîæ îõîïëþº ïåðñîíàëüí³ õàðàê-
òåðèñòèêè ïàö³ºíòà. Íàñë³äêîì öüîãî “õîë³ñòè÷íî-
ãî” ï³äõîäó º òå, ùî ë³êàð³ PRM íå ïðàöþþòü
îêðåìî, îäíàê âîíè ïîòðåáóþòü çàëó÷åííÿ âåëè-
êî¿ ê³ëüêîñò³ ³íøèõ ôàõ³âö³â îõîðîíè çäîðîâ’ÿ. Âîíè
ïðàöþþòü ñï³ëüíî â ìóëüòè-ïðîôåñ³éí³é êîìàíä³,
ÿêó î÷îëþº ë³êàð ÔÐÌ, äî ñêëàäó ÿêî¿ âõîäèòü
ïàö³ºíò òà / àáî íàäàâà÷³ äîïîìîãè éîìó / ¿é.
ijàãíîñòèêà, îö³íþâàííÿ, ë³êóâàííÿ, íàâ÷àííÿ,
òðåíóâàííÿ, êîó÷èíã ³ ï³äòðèìêà öüîãî øèðîêîãî
êîëà ïàö³ºíò³â çà äîïîìîãîþ âåëèêî¿ ìóëüòè-ïðî-
ôåñ³éíî¿ êîìàíäè ³ ãîñòð³é, ï³äãîñòð³é ³ õðîí³÷í³é
ôàç³ âèìàãàþòü âèñîêîâàðò³ñíèõ ³ äîáðå îáëàäíà-
íèõ çàêëàä³â. Çàçâè÷àé â³ää³ëåííÿ ÔÐÌ íàäຠçà-
ñîáè (òà ïåðñîíàë), â òîìó ÷èñë³: åëåêòðîì³îãðàô³¿,
óëüòðàçâóêîâî¿ ä³àãíîñòèêè, äèíàìîìåòð³¿, àíàë³çó
õîäè, íåéðîïñèõîëîã³÷íîãî òåñòóâàííÿ, ã³ìíàñòè÷-
íîãî çàëó, ê³ìíàò äëÿ åðãîòåðàﳿ, áàñåéíó, àïàðàò-
íî¿ ô³ç³îòåðàﳿ òîùî.
Øèðîêèé ñïåêòð ïàö³ºíò³â, çîñåðåäæåí³ñòü íà
ïîðóøåíÿõ, îáìåæåííÿõ àêòèâíîñò³ òà îáìåæåí-
íÿõ ìîæëèâîñò³ ó÷àñò³, óâàãà äî îñîáèñòèõ ôàê-
òîð³â òà ôàêòîð³â ñåðåäîâèùà, ìóëüòè-ïðîôåñ³éíà
êîìàíäà, íåîáõ³äí³ñòü â îáëàäíàíí³ òà ³íøèõ çàñî-
áàõ ðîáèòü ÔÐÌ ñêëàäíîþ, ìóëüòèìîäàëüíîþ òà
âñåîñÿæíîþ ñïåö³àëüí³ñòþ.
Êîæåí ïàö³ºíò, çàçâè÷àé, îòðèìóº øèðîêèé
ñïåêòð âòðó÷àíü, ùî íàäàþòüñÿ øèðîêèì êîëîì
ôàõ³âö³â îõîðîíè çäîðîâ’ÿ. Öå ìîæå âêëþ÷àòè,
çîêðåìà, âòðó÷àííÿ ç ô³çè÷íèìè âïðàâàìè, åðãî-
òåðàï³þ, òåðàï³þ ìîâè, íåéðîïñèõîëîã³÷í³ âòðó÷àí-
íÿ, ïîâåä³íêîâó òåðàï³þ, ô³çè÷íó òåðàï³þ, ìà-
íóàëüí³ âòðó÷àííÿ. Êîæåí ïàö³ºíò îòðèìóº
66 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
óí³êàëüíèé, ïîâí³ñòþ ìóëüòèìîäàëüíèé òà ³íäèâ³-
äóàëüíèé òåðàïåâòè÷íèé ï³äõ³ä, çã³äíî äî éîãî õâî-
ðîáè, ïîðóøåíü, îáìåæåíü àêòèâíîñò³, îáìåæåíü
ìîæëèâîñò³ ó÷àñò³, ôàêòîð³â ñåðåäîâèùà òà îñî-
áèñòèõ ôàêòîð³â.
Ñòàð³ííÿ íàñåëåííÿ â³ä³ãðຠâåëè÷åçíèé âïëèâ
íà íàäàííÿ ïîñëóã, à òàêîæ íà ëþäåé ç îáìåæåí-
íÿìè æèòòºä³ÿëüíîñò³: öå íàâïàêè âïëèâຠíà ñïåö³-
àëüí³ñòü òà âòðó÷àííÿ ÔÐÌ. гäêî ïàö³ºíòè ï³ñëÿ
ïåâíîãî â³êó ìàþòü ò³ëüêè îäíó õâîðîáó; ð³äêî íà
îñíîâíó õâîðîáó, íà ÿêó ñïðÿìîâàíå âòðó÷àííÿ
ÔÐÌ, íå âïëèâàþòü ³íø³ âàæëèâ³ çàõâîðþâàííÿ.
«Ñèíäåì³÷íà» êîíöåïòóàëüíà ìîäåëü11, ÿêà íåùî-
äàâíî ðîçðîáëåíà, äîáðå ïàñóº äî ï³äõîäó ÔÐÌ
ùîäî ñóïóòíüî¿ ïàòîëî㳿. Ôàêòè÷íî, âîíà ï³äêðåñ-
ëþº ñèíåðãåòè÷íó ðîëü õâîðîá òà (ñîö³àëüíèé)
êîíòåêñò ó âïëèâ³ íà êë³í³÷íèé ïåðåá³ã ³ ñèëüíî
çàëåæèòü â³ä á³îñîö³àëüíî¿ êîíöåïö³¿ çäîðîâ’ÿ.
Òîìó âòðó÷àííÿ ïîâèíí³ ïîñò³éíî àäàïòóâàòè-
ñÿ, çàäëÿ á³ëüøî¿ ³íäèâ³äóàë³çàö³¿ ï³äõîä³â. Õîë³-
ñòè÷íèé ï³äõ³ä ÔÐÌ ôîêóñóºòüñÿ íà ëþäèí³ â ö³ëî-
ìó, ç ìåòîþ ïîë³ïøåííÿ éîãî àáî ¿¿ àêòèâíîñò³ òà
çá³ëüøåííÿ éîãî àáî ¿¿ ó÷àñò³, íåìèíó÷å âðàõîâó-
þ÷è âñ³ ñóïóòí³ çàõâîðþâàííÿ, ùî âïëèâàþòü íà
âòðó÷àííÿ ³ ðåçóëüòàòè.
Á³ëüø òîãî, ñóïóòí³ çàõâîðþâàííÿ çàçâè÷àé íå
îö³íþþòüñÿ ñêåðîâóþ÷èìè ñïåö³àë³ñòàìè, ó âèïàä-
êàõ, ÿêùî ïàö³ºíòè ïåðåâîäÿòüñÿ ç ãîñòðèõ
â³ää³ëåíü, ³ âîíè ÷àñòî âèìàãàþòü ä³àãíîñòè÷íî¿
îö³íêè ë³êàðÿìè ÔÐÌ ïðè íàäõîäæåíí³ äî ï³äãîñ-
òðèõ â³ää³ëåíü. Ñóïóòí³ çàõâîðþâàííÿ ñèëüíî âïëè-
âàþòü íà òÿãàð äîïîìîãè òà íà ô³íàëüí³ ðåçóëüòà-
òè: íàðàç³ ðîçðîáëÿþòüñÿ ñïåöèô³÷í³ øêàëè, ÿê³
äîçâîëÿþòü êðàùå çðîçóì³òè, âèâ÷èòè òà êë³í³÷íî
êåðóâàòè ¿õ âïëèâîì â ïðîöåñ³ ÔÐÌ.
Ìóëüòè-ïðîôåñ³éíà êîìàíäà ÔÐÌ,
î÷îëþâàíà ë³êàðåì ÔÐÌ
˳êàð³ ÔÐÌ íàäàþòü âòðó÷àííÿ äâîìà ð³çíèìè
ñïîñîáàìè: ÿê ³ ó áàãàòüîõ ³íøèõ ñïåö³àëüíîñòÿõ,
âîíè ðîáëÿòü öå îñîáèñòî, âèêîðèñòîâóþ÷è ñïå-
ö³àëüí³ òåõí³êè (íàïð. ³íòåðâåíö³éíó ÔÐM, ³í’ºêö³¿,
ìàí³ïóëÿö³¿ “manu medica” òîùî); íàòîì³ñòü, äî-
ñèòü ñïåöèô³÷íèé äëÿ ÔÐÌ ñïîñ³á – öå ïðîâåäåí-
íÿ òåðàﳿ çà äîïîìîãîþ êîìàíäíî¿ ðîáîòè. Îñ-
òàííº îñîáëèâî â³ðíî, êîëè â³äáóâàºòüñÿ ïðîöåñ
ðåàá³ë³òàö³¿ ç âêëþ÷åííÿì ³íøèõ ôàõ³âö³â ðåàá³ë³-
òàö³¿ íå ë³êàðñüêèõ ñïåö³àëüíîñòåé.
Äîñÿãíåííÿ óñï³øíî¿ ðåàá³ë³òàö³¿ ïîòðåáóº ÷èñ-
ëåííèõ ôàõ³âö³â îõîðîíè çäîðîâ’ÿ ç øèðîêèì ñïåê-
òðîì êë³í³÷íèõ íàâè÷îê òà äîñâ³äó. Âîíè ïîâèíí³
ïðàöþâàòè ðàçîì ãàðìîí³éíî, àëå òàêîæ åôåêòèâ-
íî, ÿê êîìàíäà, çàäëÿ äîñÿãíåííÿ ö³ëåé ðåàá³ë³òàö³¿
äëÿ ïàö³ºíò³â òà ¿õ ðîäèí. Öåé ñòèëü ìóëüòè-ïðî-
¹2(2) *2018

ôåñ³éíî¿ êîìàíäíî¿ ðîáîòè, â³äð³çíÿº ÔÐÌ â³ä áà-
ãàòüîõ ³íøèõ ñïåö³àëüíîñòåé. Îá’ºäíàíà ãðóïîâà
àêòèâí³ñòü åôåêòèâíî¿ êîìàíäè ïîâèííà çàáåçïå-
÷óâàòè ñèíåðã³þ ³ ïðèçâîäèòè äî êðàùèõ ðåçóëü-
òàò³â, í³æ ñóìà ðåçóëüòàò³â ðîáîòè êîæíî¿ îêðåìî¿
ëþäèíè, ùî ïðàöþº ïîîäèíö³12-14.
Íàâ³òü ÿêùî ïðèðîäà öèõ êîìàíä º ìóëüòè-ïðî-
ôåñ³éíîþ, òåðì³íè, ùî âèêîðèñòîâóþòüñÿ â ë³òå-
ðàòóð³ ç ìåäèöèíè òà ìåíåäæìåíòó, ìîæóòü âèê-
ëèêàòè çàïëóòàí³ñòü, îñê³ëüêè ³ñíóþòü ð³çí³
êîìàíäí³ ï³äõîäè àáî ìîäåë³, ùî âèçíà÷àþòüñÿ
çàëåæíî â³ä âçàºìî䳿 ì³æ ÷ëåíàìè êîìàíäè. Îòæå,
ñïîñîáè, â ÿêèõ ïðàöþº ìóëüòè-ïðîôåñ³éíà êîìàí-
äà, áóëè âèçíà÷åí³ ð³çíèìè ìîäåëÿìè: ìóëüòè-, ì³æ-
òà òðàíñäèñöèïë³íàðíèìè ç ð³çíèìè çíà÷åííÿìè.
Ìóëüòè-äèñöèïë³íàðíà êîìàíäíà ìîäåëü âèêîðè-
ñòîâóº íàâè÷êè ëþäåé ç ð³çíèõ äèñöèïë³í, ïðîòå
êîæíà äèñöèïë³íà âñå æ ï³äõîäèòü äî ïàö³ºíòà ç
éîãî âëàñíî¿ òî÷êè çîðó, ³ çàçâè÷àé ë³êàð ñï³ëêóºòü-
ñÿ ç ³íøèìè ïðîôåñ³îíàëàìè êîìàíäè. Ìîäåëü
ì³æäèñöèïë³íàðíî¿ êîìàíäè îá’ºäíóº ï³äõ³ä ð³çíèõ
äèñöèïë³í ç âèñîêèì ð³âíåì ñï³âïðàö³ òà ñï³ëêóâàí-
íÿ ì³æ ïðîôåñ³îíàëàìè êîìàíäè, ùî âèêîðèñòîâó-
þòü óçãîäæåíó òà ñï³ëüíó ñòðàòåã³þ; êåð³âíèöòâî
êîìàíäè çàëèøàºòüñÿ â ðóêàõ îäíîãî ë³êàðÿ ÔÐÌ.
Ó ìîäåë³ òðàíñäèñöèïë³íàðíî¿ êîìàíäè ìåæ³ ïðî-
ôåñ³éíî¿ ïðàêòèêè ðîçìèò³, ³ áóäü-ÿêèé ôàõ³âåöü
çäàòíèé ïðàöþâàòè â áóäü-ÿê³é êîíêðåòí³é ðîë³
êîìàíäè 15,16.
̳æ-äèñöèïë³íàðíèé ï³äõ³ä ó ìóëüòè-ïðî-
ôåñ³éí³é êîìàíä³ º áàæàíîþ ìîäåëëþ ðîáîòè êî-
ìàíäè. Ïðîòå, íàâ³òü ÿêùî öå íå º íàéá³ëüø äîðå÷-
íîþ â³äïîâ³ääþ íà ïîòðåáè ïàö³ºíòà, òà íå
çàáåçïå÷óº õîðîøó ïðîãðàìó ðåàá³ë³òàö³¿, ³íø³ ìî-
äåë³ ìîæíà òàêîæ çíàéòè â ð³çíèõ ðåàá³ë³òàö³éíèõ
çàêëàäàõ, òàêèõ ÿê ìóëüòè-äèñöèïë³íàðíèé ï³äõ³ä
ó â³ää³ëåíí³ ãîñòðî¿ äîïîìîãè àáî òðàíñ-äèñöèïë³-
íàðíèé ï³äõ³ä ó âèïàäêàõ äîâãîñòðîêîâî¿ äîïîìî-
ãè â ãðîìàä³ äëÿ ïàö³ºíò³â ç îñâ³òí³ìè ïîòðåáàìè.
Ó á³ëüøîñò³ çàêëàä³â ì³æ-äèñöèïë³íàðíà ìîäåëü º
íàéåôåêòèâí³øîþ, îñê³ëüêè öå äîçâîëÿº çàñòîñî-
âóâàòè ñï³ëüíèé, õîë³ñòè÷íèé ³ ïàö³ºíò-öåíòðè÷íèé
ï³äõ³ä äî ðåàá³ë³òàö³¿17. Çâàæàþ÷è íà óñ³ ö³ ïðè÷è-
íè â ö³é êíèç³ ìè ââàæàºìî çà êðàùå òåðì³í
«ñï³ëüíèé», ùî â³äíîñèòüñÿ äî êîìàíäíî¿ ðîáîòè,
îñê³ëüêè ð³çí³ ìîäåë³ ìîæóòü çàñòîñîâóâàòèñÿ
åôåêòèâíî â ð³çíèõ çàêëàäàõ. Êîìàíäà ÔÐÌ ï³ä
â³äïîâ³äàëüí³ñòþ ë³êàðÿ ÔÐÌ, ïîâèííà óçãîäèòè ³
âñòàíîâèòè ðåàë³ñòè÷í³ ö³ë³ ðàçîì ç ïàö³ºíòàìè òà
¿õ ðîäèíàìè, à ïîò³ì ñï³ëüíî ïðàöþâàòè íàä äîñÿã-
íåííÿì öèõ ö³ëåé ç âèêîðèñòàííÿì ñï³ëüíî¿ ñòðà-
òå㳿. Íàé÷àñò³øå öå ìîæíà çðîáèòè ñï³ëüíèìè
ñåñ³ÿìè, ÿê³ ìîæóòü äîïîìîãòè óíèêíóòè íàäì³ðíî¿
ñòèìóëÿö³¿, âòîìè àáî ïîâòîðåíü.
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 3 – ÏÅÐÂÈÍÍÀ ÌÅÄÈ×ÍÀ ÑÏÅÖ²ÀËÜͲÑÒÜ: ÎÑÍÎÂÈ ÔÐÌ
Äîêàçè ñâ³ä÷àòü, ùî çàâäÿêè ìóëüòè-ïðî-
ôåñ³éí³é ñï³ëüí³é êîìàíäí³é ðîáîò³ ìîæå áóòè äî-
ñÿãíóòî ïîë³ïøåííÿ ôóíêö³îíàëüíèõ ðåçóëüòàò³â ³
íàâ³òü á³ëüø âèñîêà âèæèâàí³ñòü ïðè áàãàòüîõ
ñòàíàõ, çîêðåìà, ïðè ³íñóëüò³, ÷åðåïíî-ìîçêîâ³é
òðàâì³, ïåðåëîìàõ ñòåãíà, ëåãåíåâî¿ ðåàá³ë³òàö³¿ ³
áîëþ â ñïèí³17-19.
²íòåðïðåòàö³ÿ òà çàñîáè îòðèìàííÿ ãàðíîãî
ñï³ëüíîãî ï³äõîäó äëÿ ìóëüòè-ïðîôåñ³éíî¿ êîìàí-
äè â³äð³çíÿþòüñÿ çàëåæíî â³ä çàêëàä³â. Ó â³ää³ëåíí³
ÔÐÌ (ó ë³êàðíÿõ ãîñòðî¿ òà ï³äãîñòðî¿ äîïîìîãè)
âñ³ ôàõ³âö³ ïðàöþþòü ðàçîì â îäíîìó ï³äðîçä³ë³ ï³ä
â³äïîâ³äàëüí³ñòþ ë³êàðÿ ÔÐÌ. Îáåðò ïàö³ºíò³â
â³äíîñíî íèçüêèé, ÷àñ ðåàá³ë³òàö³¿ äîñèòü òðèâàëèé,
à â³äïîâ³äü ïàö³ºíò³â íà âòðó÷àííÿ äîñèòü øâèä-
êà. Âñ³ ö³ ôàêòîðè â³ä³ãðàþòü âàæëèâó ðîëü ó âèç-
íà÷åíí³ ï³äõîäó äî óïðàâë³ííÿ êîìàíäîþ, ÿêèé
ââàæàºòüñÿ “êëàñè÷íèì” ó ÔÐÌ, îñê³ëüêè º
íàéá³ëüø âèâ÷åíèì.
Ó ãîñòð³é ë³êàðí³ ç öåíòðàëüíèì â³ää³ëåííÿì
ÔÐÌ ìóëüòè-ïðîôåñ³éíà êîìàíäà â³ää³ëåííÿ ÔÐÌ
â³äïîâ³äຠçà âñ³ ïèòàííÿ ðåàá³ë³òàö³¿ ó ãîñòðîìó
øïèòàë³. Ìóëüòè-ïðîôåñ³éíà êîìàíäà ÔÐÌ ä³º â
ðîë³ êîíñóëüòàíò³â äëÿ âñ³õ â³ää³ëåíü. Ìóëüòè-ïðî-
ôåñ³éíà êîìàíäà ñêëàäàºòüñÿ ç ë³êàð³â ÔÐÌ ³
ôàõ³âö³â ðåàá³ë³òàö³¿ ï³ä êåð³âíèöòâîì ë³êàðÿ ÔÐÌ.
Ìóëüòè-ïðîôåñ³éíà êîìàíäà ñï³âïðàöþº ç ³íøèìè
ñïåö³àë³ñòàìè â ³íøèõ â³ää³ëåííÿõ, äå á âîíè íå
áóëè ïîòð³áí³.
Òàêîæ, àìáóëàòîðí³ çàêëàäè ïîâèíí³ çàáåçïå÷ó-
âàòè ìóëüòè-ïðîôåñ³éí³ êîìàíäè, ùî ïðàöþþòü
ñï³ëüíî ç ³íøèìè ôàõ³âöÿìè, ï³ä êåð³âíèöòâîì ë³êà-
ðÿ ÔÐÌ. Ïðîòå, êîìàíäè ìîæóòü áóòè íåïîâíèìè
àáî ³íîä³ çäàâàòèñÿ, ùî ³ íå ³ñíóþòü, îñîáëèâî êîëè
ë³êàð ÔÐÌ ³ ôàõ³âö³ ðåàá³ë³òàö³¿, ÿê³ çàáåçïå÷óþòü
âòðó÷àííÿ, íàâ³òü íå ïðàöþþòü â îäíîìó ³ òîìó æ
ì³ñö³ ñï³ëüíî¿ ðîáîòè. Êîìàíäè ìîæóòü ïðàöþâà-
òè áåç ô³çè÷íî¿ ïðèñóòíîñò³ îäíîãî àáî äåê³ëüêîõ
ôàõ³âö³â ðåàá³ë³òàö³¿, àëå çàâæäè ï³ä â³äïîâ³äàëü-
í³ñòþ ë³êàðÿ ÔÐÌ. ²íø³ ñïåöèô³÷í³ õàðàêòåðèñòè-
êè öèõ çàêëàä³â âêëþ÷àþòü âåëè÷åçíó ê³ëüê³ñòü
ïàö³ºíò³â, øâèäêèé îáåðò, êîðîòêèé ÷àñ äëÿ îö³íþ-
âàííÿ ³ âòðó÷àííÿ (äåê³ëüêà ñåàíñ³â) ³ øâèäêà ðå-
àêö³ÿ íà âòðó÷àííÿ. Î÷åâèäíî, ùî â öèõ âèïàäêàõ
çðîñòàþòü òðóäíîù³ â êîìàíäíîìó ï³äõîä³, à ìå-
íåäæìåíò ïàö³ºíò³â çàñíîâàíèé íà ïðîòîêîëàõ òà/
àáî ïðîñòèõ ïðèçíà÷åííÿõ: ó ðàç³ âèíÿòê³â ç ïðî-
òîêîë³â, ðîçá³æíîñòåé òà/àáî îñîáëèâèõ êë³í³÷íèõ
âèïàäêàõ íåîáõ³äí³ áåçïîñåðåäí³ ïèñüìîâ³ òà/àáî
óñí³ êîíòàêòè ì³æ ôàõ³âöÿìè. Ìîæëèâî òàêîæ ïëà-
íóâàííÿ íàðàä êîìàíäè, õî÷à ³ ç ìåíøîþ ÷àñòî-
òîþ. Äóæå áëèçüêîþ äî öüîãî ôîðìàòó º ñèòóàö³ÿ
ç òàê çâàíîþ “ï³ñëÿðåàá³ë³òàö³ºþ” òà/àáî ï³äòðèì-
êà àêòèâíîñò³ ó õðîí³÷íèõ ïàö³ºíò³â. ²íîä³ ñòâåðä-
æóºòüñÿ, ùî ö³ çàêëàäè íå º êë³í³÷íèìè ³ çíàõîäÿòü-
67
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ñÿ ïîçà ñôåðîþ ä³ÿëüíîñò³ ðåàá³ë³òàö³éíî¿ êîìàí-
äè, àëå ìåíåäæìåíò öèõ ñêëàäíèõ ïàö³ºíò³â çàçâè-
÷àé º óòðóäíåíèì, ³ âîíè ïåð³îäè÷íî âèìàãàþòü
êëàñè÷íèõ ðåàá³ë³òàö³éíèõ âòðó÷àíü: îòæå, â öèõ
âèïàäêàõ êîìàíäíèé ï³äõ³ä º á³ëüø äîö³ëüíèì,
íàâ³òü ÿêùî çàñòîñîâóþòüñÿ á³ëüø ëåãê³ ñòðàòå㳿.
²íøîþ ñèòóàö³ºþ äëÿ óïðàâë³ííÿ êîìàíäíîþ
ðîáîòîþ º çàêëàäè ÔÐÌ äîâãîòðèâàëî¿ äîïîìîãè,
äå îáåðò ïàö³ºíò³â ³ êë³í³÷í³ çì³íè ¿õ ñòàíó â³äáó-
âàþòüñÿ äóæå ïîâ³ëüíî, à ðåàá³ë³òàö³éí³ âòðó÷àí-
íÿ ñêîðî÷åí³. Ó öèõ âèïàäêàõ êîìàíäí³ çóñòð³÷³ âñå
ùå ìîæëèâ³, àëå ç äóæå íèçüêîþ ÷àñòîòîþ.
Óñï³øíà ðîáîòà ðåàá³ë³òàö³éíî¿ êîìàíäè âèìà-
ãຠïåâíèõ îñîáëèâîñòåé, íàâ³òü ÿêùî íå âñ³ âîíè
ìîæëèâ³ â ð³çíèõ çàçíà÷åíèõ óñòàíîâàõ:
– ìåíåäæìåíò ³ ë³äåðñòâî: ë³êàð³ ÔÐÌ º êë³í³÷íè-
ìè ìåíåäæåðàìè ³ ïîâèíí³ áóòè õîðîøèìè ë³äå-
ðàìè ðåàá³ë³òàö³éíî¿ êîìàíäè: äîäàòêîâî, âîíè
ïîâèíí³ áóòè çäàòí³ êåðóâàòè ãðóïàìè ôàõ³âö³â,
ðîçâ’ÿçóâàòè ïðîáëåìè, ñïðèÿòè äèñêóñ³¿, ïðèé-
ìàòè ð³øåííÿ ³ ñëóõàòè;
– ³ºðàðõ³ÿ: íàâ³òü ïðè â³äñóòíîñò³ ïðÿìèõ ³ºðàð-
õ³÷íèõ â³äíîñèí (ùî íåìîæëèâî ïðè ðîáîò³ íà
ð³çíèõ ï³äðîçä³ëàõ), ó âñ³õ ñèñòåìàõ îõîðîíè
çäîðîâ’ÿ ìຠáóòè îñîáà, ÿêà â ê³íöåâîìó
ï³äñóìêó íåñå â³äïîâ³äàëüí³ñòü çà ïàö³ºíò³â, ³ çà
ïðèéíÿòòÿ êë³í³÷íèõ ð³øåíü: öå ë³êàð, çàçâè÷àé
ë³êàð³ ÔÐÌ, ùî çíàõîäÿòüñÿ â â³äíîñèíàõ ôóí-
êö³îíàëüíî¿ ³ºðàðõ³¿;
– ÷àñ: â³äïîâ³äíèé ÷àñ ìຠáóòè ïðèñâÿ÷åíèé çà-
õîäàì ç ïîáóäîâè êîìàíäè, ÿêå ìîæå âàð³þâà-
òèñÿ â çàëåæíîñò³ â³ä ï³äðîçä³ëó. Îñê³ëüêè ðå-
àá³ë³òàö³ÿ íåìîæëèâà áåç êîìàíäè, öå ïðàâèëüíî
âèä³ëåíèé ðîáî÷èé ÷àñ, ÿêèé ³ íå ò³ëüêè ïîêðà-
ùóº ñòàíäàðòè êë³í³÷íî¿ ðîáîòè, àëå ³ ä³éñíî
äîçâîëÿº êîìàíä³ ôóíêö³îíóâàòè;
– ïîâàãà äî ðîëåé ³ ïðîôåñ³é: âñ³ ÷ëåíè êîìàíäè
ìàþòü ð³çí³ êîìïåòåíòíîñò³, ÿê³ ïîâèíí³ áóòè
âèçíàí³ âñ³ìà ³íøèìè; ðîë³ º ð³çíèìè, ³ ³ñíóº
³ºðàðõ³ÿ ç ë³äåðñòâîì ë³êàðÿ ÔÐÌ, ÿêó íåîáõ³-
äíî ïîâàæàòè;
– ïåðñîíàëüí³ ôàêòîðè: êîìàíäè ôóíêö³îíóþòü,
ÿêùî ëþäè ðîáëÿòü ¿õ ôóíêö³îíóþ÷èìè. ª ÷³òêî
ïåðñîíàëüí³ ôàêòîðè, òàê³ ÿê ãîòîâí³ñòü äî çì³í,
çäàòí³ñòü ñï³âïðàöþâàòè, íàâ÷àííÿ êîìàíäí³é
ðîáîò³, äîñòàòí³é áàëàíñ âíóòð³øí³õ ñèë, ùîá
ïðèéíÿòè, ùî âàøà âëàñíà ðîáîòà ìîæå îáãî-
âîðþâàòèñÿ ³ ³íîä³ îñêàðæóâàòèñÿ, à òàêîæ
óì³ííÿ ñëóõàòè ³ äàâàòè âèñëîâèòèñÿ ³íøèì.
Ö³ì ôàêòîðàì ìîæëèâî ëèøå ÷àñòêîâî íàâ÷è-
òèñü, àëå âîíè íåîáõ³äí³ äëÿ çä³éñíåííÿ ðåàá³ë³-
òàö³éíî¿ ïðàêòèêè âñ³ìà ôàõ³âöÿìè;
– ôàêòîðè ñåðåäîâèùà: çàãàëüí³ ñòàâëåííÿ íà ðî-
áî÷îìó ì³ñö³ (âñåðåäèí³ ðåàá³ë³òàö³éíîãî
â³ää³ëåííÿ ³ ïîçà íèì, âêëþ÷íî ç àäì³í³ñòðàòèâ-
68 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
íèì óïðàâë³ííÿì) â³ä³ãðàþòü âàæëèâó ðîëü ó
ñïðèÿíí³ àáî ïåðåøêîäæàíí³ êîìàíäí³é ðîáîò³;
ë³êàð³ ÔÐÌ ìàþòü âàæëèâó ðîëü â ñïðèÿíí³
ñòàâëåíü ñåðåäîâèùà. Á³ëüø òîãî, ñïåöèô³÷í³
³íñòðóìåíòè ³ çàñîáè êîìóí³êàö³¿ ïîâèíí³ ðîçðîá-
ëÿòèñÿ â³äïîâ³äíî äî ï³äðîçä³ëó.
Ïîñèëàííÿ
1. World Health Organization. International Classification of
Impairments, Disabilities, and Handicaps. 1980. 207 p.
2. World Health Organization. WHO | International Classification
of Functioning, Disability and Health (ICF) [Internet]. WHO.
[cited 2014 Aug 19]. Available from: http://www.who.int/
classifications/icf/en/
3. Engel G.L. The need for a new medical model: a challenge for
biomedicine. Science. 1977 Apr 8;196(4286):129–36.
4. Engel G.L. The biopsychosocial model and the education
of health professionals. Ann N Y Acad Sci. 1978 Jun
21;310:169–87.
5. Negrini S., Frontera W.R. The Euro-American rehabilitation
focus: a cultural bridge across the ocean. Am. J. Phys. Med.
Rehabil. 2008 Jul;87(7):590–1.
6. Negrini S., Frontera W. The Euro-American Rehabilitation
Focus: a cultural bridge across the ocean. Eur. J. Phys. Rehabil.
Med. 2008 Jun;44(2):109–10.
7. Stucki G., Cieza A., Melvin J. The International Classification
of Functioning, Disability and Health (ICF): a unifying model
for the conceptual description of the rehabilitation strategy.
J Rehabil Med. 2007 May;39(4):279–85.
8. Stucki G. International Classification of Functioning,
Disability, and Health (ICF): a promising framework and
classification for rehabilitation medicine. Am. J. Phys. Med.
Rehabil. 2005 Oct;84(10):733–40.
9. Stucki G., Grimby G. Applying the ICF in medicine. J Rehabil
Med. 2004 Jul;(44 Suppl):5–6.
10. Stucki G., Usten T.B., Melvin J. Applying the ICF for the
acute hospital and early post-acute rehabilitation facilities.
Disabil Rehabil. 2005 Apr 8;27(7–8):349–52.
11. The Lancet null. Syndemics: health in context. Lancet Lond
Engl. 2017 Mar 4;389(10072):881.
12. Joel A. Delisa and contributors. Physical Medicine &
Rehabilitation: Principles and Practice. section 3. 4th Edition.
Lippincott Williams & Wilkins; Volume 1; 2005.
13. Bokhour B.G. Communication in interdisciplinary team
meetings: what are we talking about? J. Interprof. Care. 2006
Aug;20(4):349–63.
14. Behm J., Gray N. Chapter 5: Interdisciplinary Rehabilitation
Teams. In Rehabilitation nursing: a contemporary approach
to practice. Jones & Bartlett Learning 2012. USA; 2012.
15. Körner M. Interprofessional teamwork in medical
rehabilitation: a comparison of multidisciplinary and
interdisciplinary team approach. Clin Rehabil. 2010
Aug;24(8):745–55.
16. Norrefalk J.-R. How do we define multidisciplinary
rehabilitation? J. Rehabil. Med. 2003 Mar;35(2):100–1.
17. Neumann V., Gutenbrunner C., Fialka-Moser V.,
Christodoulou N., Varela E., Giustini A., et al. Interdisciplinary
team working in physical and rehabilitation medicine. J.
Rehabil. Med. 2010 Jan;42(1):4–8.
18. Momsen A.-M., Rasmussen J.O., Nielsen C.V., Iversen M.D.,
Lund H. Multidisciplinary team care in rehabilitation: an
overview of reviews. J Rehabil Med. 2012 Nov;44(11):901–12.
19. Semlyen J.K., Summers S.J., Barnes M.P. Traumatic brain
injury: efficacy of multidisciplinary rehabilitation. Arch. Phys.
Med. Rehabil. 1998 Jun;79(6):678–83.
¹2(2) *2018
 ÐÎÇÄ²Ë 3 – ÏÅÐÂÈÍÍÀ ÌÅÄÈ×ÍÀ ÑÏÅÖ²ÀËÜͲÑÒÜ: ÎÑÍÎÂÈ ÔÐÌ

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Stefano Negrini,
Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner,
Carlotte Kiekens, Sasa Moslavac, Enrique Varela-Donoso, Anthony B Ward, Mauro Zampolini.
• Ó÷àñíèêè: Gordana Deveèerski, Calogero Foti, Stefano Negrini, Rajiv K Singh, Henk J. Stam, Carlotte
Kiekens, Ayse A. Kucukdeveci, Eugenia Rosulescu, María Amparo Martinez Assucena, Nino Basaglia,
Catarina Aguiar Branco, Andrew J. Haig, Alvydas Juocevicius, Renato Nunes, Dominic Perennou, Nicola
Smania, Gerold Stucki, Luigi Tesio, Aivars Vetra.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 69
 Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐM) â ªâðîï³
Ðîçä³ë 4 – ²ñòîð³ÿ ñïåö³àëüíîñò³: çâ³äêè ïîõîäèòü ÔÐÌ
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
 êîíòåêñò³ Á³ëî¿ êíèãè ô³çè÷íî¿ ³ ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ÔÐÌ) â ªâðîï³, öåé ðîçä³ë ïðèñâÿ÷åíèé ³ñòî𳿠ìåäè÷íî¿
ñïåö³àëüíîñò³ ÔÐÌ. Ñïåö³àëüí³ñòü åâîëþö³îíóâàëà â ð³çíèõ ºâðîïåéñüêèõ êðà¿íàõ, à ³íîä³ òàêîæ ³ â îêðåìèõ êðà¿íàõ, ç
ð³çíèõ ìåäè÷íèõ íàïðÿìê³â, ÿê³, âðåøò³-ðåøò, îá’ºäíàëèñÿ. Äî íèõ íàëåæàòü: áàëüíåîëîã³ÿ, ã³ìíàñòèêà, âèêîðèñòàííÿ
ô³çè÷íèõ àãåíò³â (âîäà, òåïëî, õîëîä, ìàñàæ, ìàí³ïóëÿö³¿ ç ñóãëîáàìè, ô³çè÷í³ âïðàâè òîùî). Ùå îäíó âàæëèâó ðîëü
ç³ãðàâ ôàêò çá³ëüøåííÿ ê³ëüêîñò³ ëþäåé, ÿê³ çàçíàëè àáî ìîæóòü çàçíàòè îáìåæåíü æèòòºä³ÿëüíîñò³ çàâäÿêè ïîë³ïøåí-
íþ ìåäèöèíè, ùî, ÿê íàñë³äîê, ïðèçâåëî äî ï³äâèùåííÿ âèæèâàíîñò³ ï³ä ÷àñ â³éí, íåùàñíèõ âèïàäê³â ³/àáî âåëèêèõ
³íôåêö³éíèõ åï³äåì³é (òàêèõ ÿê ïîë³î쳺ë³ò); öÿ åâîëþö³ÿ â³äáóâàëàñü â ïðÿìîìó âçàºìîçâ’ÿçêó ç ðîçâèòêîì òàêèõ
ñïåö³àëüíîñòåé, ÿê êàðä³îëîã³ÿ, íåâðîëîã³ÿ, îðòîïåä³ÿ, ïíåâìîëîã³ÿ, ðåâìàòîëîã³ÿ, òðàâìàòîëîã³ÿ, òèì ñàìèì ñòâîðþþ-
÷è äîñâ³ä, ùî º òðàíñâåðçàëüíèì äëÿ êîæíî¿ ç íèõ. Îòæå, ñïåö³àëüí³ñòü ÔÐÌ ïîñòóïîâî âïðîâàäæóâàëàñÿ â ð³çíèõ
ºâðîïåéñüêèõ êðà¿íàõ, ïðîòå áåç îäíîð³äíîñò³. Çãîäîì áóëè ñòâîðåí³ ªâðîïåéñüê³ Îðãàí³çàö³¿ äëÿ ¿¿ ïîøèðåííÿ ³ êîîð-
äèíàö³¿ íà ð³âí³ ìåäè÷íèõ êîìïåòåíòíîñòåé ³ äîïîìîãè ïàö³ºíòàì, à òàêîæ ìåäè÷íîãî íàâ÷àííÿ ³ äîñë³äæåíü: ªâðîïåéñüêà
Ôåäåðàö³ÿ Ô³çè÷íî¿ Ìåäèöèíè òà Ðåàá³ë³òàö³¿ – ï³çí³øå ªâðîïåéñüêå Òîâàðèñòâî (ªÒÔÐÌ), Acad mie M dicale
Europenne de M decine R adaptation (EARME), Ñåêö³ÿ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â òà ªâðî-
ïåéñüêèé Êîëåäæ ÔÐÌ (â îñîá³ Ðàäè ÔÐÌ ªÑÌÑ), áóëè ñòâîðåí³ ³ ïðàöþþòü ñüîãîäí³ çàðàäè öèõ çàãàëüíèõ ö³ëåé. Â
äàíèé ÷àñ â ªâðîï³ ³ñíóº ºäèíå âèçíà÷åííÿ ñïåö³àëüíîñò³, ÿêå óçãîäæóºòüñÿ ç ì³æíàðîäíî âèçíàíèì îïèñîì ÔÐÌ (íà
îñíîâ³ ìîäåë³ ÌÊÔ). Á³ëüø òîãî, ð³âåíü äîñë³äæåíü â îáëàñò³ ÔÐÌ çíà÷íî ï³äâèùèâñÿ â îñòàíí³ äåñÿòèë³òòÿ çàâäÿêè
ïåâíèì çîâí³øí³ì òà âíóòð³øí³ì íàóêîâèì âïëèâàì, òèì ñàìèì çá³ëüøóþ÷è ¿¿ íàóêîâå çíà÷åííÿ, ðàçîì ç îäíî÷àñíèì
çá³ëüøåííÿì ê³ëüêîñò³ æóðíàë³â ç ðåàá³ë³òàö³¿, áàãàòî ç ÿêèõ áóëè ïðî³íäåêñîâàí³, äåÿê³ ç ³ìïàêò-ôàêòîðîì (Cr, EJPRM,
JRM ì³æ ³í.), òàêîæ, ÿê ïàðàëåëüíå çá³ëüøåííÿ ïðîâåäåíèõ íàóêîâèõ êîíãðåñ³â ³ êóðñ³â. Íàðåøò³, àëå íå â îñòàííþ
÷åðãó, íåùîäàâíº ñòâîðåííÿ Êîêðàí³âñüêî¿ ðåàá³ë³òàö³éíî¿ ñôåðè, à òàêîæ â³äêðèòòÿ íîâèõ ô³çè÷íèõ àãåíò³â òà òåõíî-
ëîã³é, ÿê³ çìåíøóþòü îáìåæåííÿ àêòèâíîñò³ òà îáìåæåííÿ ó÷àñò³ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³, òàêîæ äàñòü
çíà÷íèé ïîøòîâõ ö³é ïåðâèíí³é ìåäè÷í³é ñïåö³àëüíîñò³.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 4. History of the specialty: where PRM comes from. Eur J
Phys Rehabil Med. 2018 Apr;54(2):186-197.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 4. ²ñòîð³ÿ ñïåö³àëüíîñò³: çâ³äêè ïîõîäèòü ÔÐÌ.
Óêðà¿íñüêèé æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 70–81
Êëþ÷îâ³ ñëîâà: Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà, ªâðîïà, ³ñòîð³ÿ, íàóêîâ³ äîñë³äæåííÿ, íàóêîâ³ æóðíàëè.

Ââåäåííÿ ñïåö³àëüí³ñòþ. Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïî-

Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî
óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³î-
íàëüíîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòå-
ð³àë³â äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìó-
âàííÿ ïðî ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â
ðåàá³ë³òàö³¿ òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà
âàæëèâîñò³ ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ
íÿòòÿ ÔÐÌ, ÷îìó ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì
ëþäÿì ³ ñóñï³ëüñòâó, îñíîâè ÔÐÌ, ³ñòîð³ÿ ñïåö³-
àëüíîñò³ ÔÐÌ, ñòðóêòóðà ³ ä³ÿëüí³ñòü îðãàí³çàö³é
ÔÐÌ â ªâðîï³, çíàííÿ ³ íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà
êë³í³÷íèõ êîìïåòåíòíîñòåé ÔÐÌ, ì³ñöå ñïåö³àëü-
íîñò³ ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ ³ ñóñ-
ï³ëüñòâ³, îñâ³òà òà áåçïåðåðâíèé ïðîôåñ³éíèé ðîç-
âèòîê ë³êàð³â ÔÐÌ, îñîáëèâîñò³ òà ïðîáëåìè íàóêè
òà äîñë³äæåíü â ÔÐÌ òà ïðîáëåìè òà ïåðñïåêòè-
âè ìàéáóòíüîãî ÔÐÌ.
Öåé ðîçä³ë ïðèñâÿ÷åíèé ³ñòî𳿠ÔÐÌ â ªâðîï³.
³í âïåðøå áóâ ââåäåíèé äî ÁÊ, îñê³ëüêè ñó-
÷àñí³ñòü ö³º¿ ñïåö³àëüíîñò³ áàãàòî â ÷îìó îáóìîâ-

70 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018

ëåíà ¿¿ ³ñòîðè÷íèì çðîñòàííÿì. Á³ëüø òîãî, äîòå-
ïåð íå âèñòà÷àëî çàãàëüíîãî ðîçóì³ííÿ, ùî â³äáó-
âàëîñü ïî âñ³é ªâðîï³, ³ öå ðîçóì³ííÿ â³äêðèâຠíîâ³
ïåðñïåêòèâè äëÿ íàö³îíàëüíèõ ³ñòîð³é, ÿê³ ³íîä³
ñèëüíî â³äð³çíÿþòüñÿ â³ä òîãî, ùî â³äáóâàëîñÿ â
³íøèõ ºâðîïåéñüêèõ êðà¿íàõ. Ôàêòè÷íî, ñïåö³-
àëüí³ñòü âêëþ÷ຠñüîãîäí³ âñ³ ö³ íàïðÿìêè ³ º ÷àñ-
òèíîþ óí³ô³êàö³¿ ºâðîïåéñüêèõ ïðàêòèê ç ðîçóì³í-
íÿì ³ñòîð³¿, äå íàö³îíàëüí³ ïðàêòèêè ïîâèíí³ áóòè
ðîçòàøîâàí³ â ïîð³âíÿíí³ ç ³íøèìè êðà¿íàìè.
Ó öüîìó ðîçä³ë³ òàêîæ ïðåäñòàâëåíà åâîëþö³ÿ
ªâðîïåéñüêèõ Îðãàí³çàö³é, âêëþ÷àþ÷è ªâðî-
ïåéñüê³ Îðãàíè, ³íøèõ íàóêîâèõ òîâàðèñòâ òà æóð-
íàë³â, ùî çíàõîäÿòüñÿ ó ñôåð³ ÔÐÌ.
²ñòîðè÷í³ íîòàòêè ç åâîëþö³¿ ñïåö³àëüíîñò³
Ìåäè÷íà ñïåö³àëüí³ñòü ÔÐÌ ïðîéøëà ð³çí³ åòà-
ïè äî ìîìåíòó ¿¿ êîíñîë³äàö³¿ â ìèíóëîìó ñòîë³òò³.
Ó ð³çí³ ïåð³îäè ³ñòî𳿠îáèäâ³ êîíöåïö³¿ – ô³çè÷íà
ìåäèöèíà ³ ðåàá³ë³òàö³ÿ – çàçíàëè, â ö³ëîìó, çì³íè
â ³íòåðïðåòàö³¿ ñâî¿õ çíà÷åíü îäíà â³äíîñíî äî
³íøî¿. Òàêîæ â³äáóëèñÿ çì³íè ó ïðàêòèö³ ¿õ êë³í³÷íî¿
ä³ÿëüíîñò³1.
Âèêîðèñòàííÿ ô³çè÷íèõ àãåíò³â ë³êàðÿìè, â îñ-
íîâíîìó, ºâðîïåéñüêîãî ðåã³îíó, ïî÷àëîñÿ â äà-
ëåê³é äàâíèí³. Ïðèáëèçíî 100 000 ðîê³â äî í.å. â
Ganovce â Ñëîâà÷÷èí³ íåàíäåðòàëüñüê³ æ³íêè çà-
íóðþâàëèñü ó òåðìàëüí³ ì³íåðàëüí³ äæåðåëà2. Ãðå-
êè, à ïîò³ì ³ ðèìëÿíè, âèñòóïàëè çà íàñòóïíó ïðàê-
òèêó: âîäíà òåðàï³ÿ, ìàñàæ ³ ³íø³ ìîäàëüíîñò³
ìàíóàëüíî¿ ìåäèöèíè, òåïëîâ³ ³ õîëîäîâ³ ïðîöåäó-
ðè, à òàêîæ ô³çè÷í³ âïðàâè. Óñ³ ö³ ìåäè÷í³ âòðó÷àí-
íÿ âèêîíóâàëè ë³êàð³ â ñòàðîäàâí³ (óïïîêðàò, Ãà-
ëåí òîùî) òà ñåðåäí³ â³êè (Àâ³öåííà, Àâåððîéç
òîùî) ç ìåòîþ äîñÿãíåííÿ çíåáîëåííÿ, çìåíøåí-
íÿ îáìåæåíü æèòòºä³ÿëüíîñò³ òà çàãàëüíîãî áëà-
ãîïîëó÷÷ÿ. Ó áàãàòüîõ âèïàäêàõ ö³ ìîäàëüíîñò³
âèêîðèñòîâóâàëèñü äëÿ ï³äãîòîâêè ëþäåé äî
áèòâ 3,4.
Ç ïðèõîäîì Ðåíåñàíñó òà ðàçîì ç äîñÿãíåííÿ-
ìè ó çíàíí³ ñó÷àñíî¿ àíàòî쳿 òà ô³çèêè áóëè çðîá-
ëåí³ âåëèê³ çóñèëëÿ äëÿ âèêîðèñòàííÿ ô³çè÷íèõ
ìîäàëüíîñòåé, ÿê ë³êóâàííÿ. Òàê, â³äîì³ ë³êàð³, ÿê
Ïàðàöåëüñ (XV ñò.) ðåêîìåíäóâàëè ìàñàæ, ÿê íå-
çàì³ííèé çàñ³á äëÿ ï³äòðèìêè çäîðîâ’ÿ. Ambroise
Par â XVI ñòîë³òò³ çàñòîñîâóâàâ ìàñàæ äëÿ àì-
ïóòîâàíèõ êóêñ òà ï³ñëÿâîºííèõ øðàì³â, òà òàêîæ
Hieronymus Mercurialis áóâ ñïîëó÷íîþ ëàíêîþ ì³æ
ãðåöüêîþ ³ ñó÷àñíîþ ìåäè÷íîþ ã³ìíàñòèêîþ, îñ-
ê³ëüêè â³í, ì³æ ³íøèì, ðåêîìåíäóâàâ âèêîíàííÿ
ô³çè÷íèõ âïðàâ â ïîºäíàíí³ ç 䳺òîþ ³ ã³ã³ºí³÷íèìè
çàõîäàìè äëÿ ë³êóâàííÿ ð³çíèõ ïðîöåñ³â.
Ïðîòÿãîì íàñòóïíèõ ñòîë³òü ô³çè÷í³ àãåíòè
ïðîäîâæóâàëè âèêîðèñòîâóâàòèñÿ, ÿê ñïîñ³á ë³êó-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 4 – ²ÑÒÎÐ²ß ÑÏÅÖ²ÀËÜÍÎÑÒ²: DzÄÊÈ ÏÎÕÎÄÈÒÜ ÔÐÌ
âàííÿ, âêëþ÷àþ÷è âîäíó òåðàï³þ, ùî ñòâîðèëî ó
XVII ³ XVIII ñòîë³òòÿõ áåçë³÷ òåïëîâèõ çàêëàä³â
äëÿ â³äïî÷èíêó òà ë³êóâàííÿ (Richard Russell,
Vicente P rez, Siegmund Hahn òîùî)3,4.
Ó XIX ñòîë³òò³, çàâäÿêè äîêòîðó Duchenne de
Boulogne, ÿêèé ââàæàºòüñÿ áàòüêîì åëåêòðîòåðàﳿ
³ åëåêòðîä³àãíîñòèêè, åëåêòðè÷íèé ñòðóì ïî÷àëè
âèêîðèñòîâóâàòè òàêîæ ÿê ä³àãíîñòè÷íó òà ë³êó-
âàëüíó ìîäàëüí³ñòü 5; õî÷à ùå ðàí³øå, ïðîòÿãîì
XVII ñòîë³òòÿ, Êîðîë³âñüêà àêàäåì³ÿ íàóê Ôðàíö³¿
ïî÷àëà ïóáë³êóâàòè ùîð³÷í³ äîïîâ³ä³ ïðî ìåäè÷íó
åëåêòðîòåðàï³þ. Ó òîìó æ ñòîë³òò³, çàâäÿêè äîê-
òîðó Pier Henrich Ling, ÿêèé ñòâîðèâ ç³ ñâî¿ìè ó÷-
íÿìè øâåäñüêó ìåäè÷íó ã³ìíàñòèêó, âåëèêèé ïî-
øòîâõ ó ðîçâèòêó áóâ íàäàíèé ô³çè÷íèì âïðàâàì,
ÿê ë³êóâàëüí³é ìîäàëüíîñò³ äëÿ ì’ÿçîâî-ñêåëåòíèõ
ðîçëàä³â3. ϳçí³øå ³íø³ ìåòîäè ìåäè÷íî¿ ã³ìíàñòè-
êè áóëè òàêîæ îïèñàí³ â ªâðîï³. Ó òîìó æ ñòîë³òò³
³íøèé ë³êàð, Sebastian Busqu y Torró (²ñïàí³ÿ)6,
ïîñë³äîâíèê Ling, ïåðøèì â ìåäè÷í³é ë³òåðàòóð³
âèêîðèñòîâóâàâ ñëîâî “ðåàá³ë³òàö³ÿ”. Òðîõè
ï³çí³øå äîêòîð Zander (Øâåö³ÿ) ñòâîðèâ òå, ùî ìè
çàðàç çíàºìî ÿê ìåõàíîòåðàï³þ. Ó öüîìó îñòàí-
íüîìó âèïàäêó, íàïðèê³íö³ öüîãî ñòîë³òòÿ, â äåÿ-
êèõ ºâðîïåéñüêèõ ë³êàðíÿõ ³ êë³í³êàõ áóëè ñòâîðåí³
çàêëàäè ìåõàíîòåðàﳿ, ÿê³ ôóíêö³îíóâàëè ÿê ðå-
àëüí³ ðåàá³ë³òàö³éí³ êàá³íåòè, òàêîæ âîíè áóëè
ñòâîðåí³ íà äåÿêèõ ôàáðèêàõ, íàäàþ÷è ñâî¿ì ïðà-
ö³âíèêàì ô³çè÷íå ë³êóâàííÿ.
Òàêîæ â XIX ñòîë³òò³ êîíöåïö³ÿ ëîêîìîòîðíîãî
ïåðåíàâ÷àííÿ áóëà ðîçðîáëåíà ôðàíöóçüêîþ øêî-
ëîþ íåâðîëî㳿, â³äòîä³ ô³çè÷í³ âïðàâè ïî÷àëè çàñ-
òîñîâóâàòèñÿ äëÿ ë³êóâàííÿ çàõâîðþâàíü íåðâîâî¿
ñèñòåìè; ³ Jaques Delpech çàñíóâàâ â Ìîíïåëüº
øêîëó ñêîë³îçó äëÿ ë³êóâàííÿ äåôîðìàö³é õðåáòà7.
Ó òîìó æ ñòîë³òò³ âåëèêèé ïîøòîâõ ó ðîçâèòêó
îòðèìàëà âîäíà òåðàï³ÿ çàâäÿêè Sebastian Kneipp
(ͳìå÷÷èíà), Vinzenz Priessnitz (Àâñòð³ÿ) òà ³íøèì,
³ íå äèâëÿ÷èñü íà òå, ùî âîíè íå áóëè äîêòîðàìè,
¿õ ìåòîäè áóëè ïðèéíÿò³ ³ ðîçâèíåí³ ë³êàðÿìè SPA8.
Ç ³íøîãî áîêó, Andrew Taylor Still (ë³êàð ç ÑØÀ),
áàòüêî îñòåîïàò³¿, à òàêîæ Daniel David Palmer,
(ÑØÀ, íå ë³êàð), áàòüêî õ³ðîïðàêòèêè, ñòâîðèëè
îñíîâó äëÿ ðîçâèòêó äèñöèïë³íè ìàíóàëüíî¿ ìåäè-
öèíè â íàñòóïíîìó ñòîë³òò³9.
ßê çãàäóâàëîñÿ ðàí³øå, ÔÐÌ áóëà ñòâîðåíà, ÿê
ïåðâèííà ñïåö³àëüí³ñòü âïðîäîâæ ÕÕ ñòîë³òòÿ.
Ïðîöåñ ¿¿ ðîçâèòêó â ºâðîïåéñüêèõ êðà¿íàõ íå áóâ
îäíàêîâèì, ³ â îäíèõ âèïàäêàõ ¿¿ ïîõîäæåííÿ ïî-
â’ÿçàíå ç êîìá³íàö³¿ ñïåö³àëüíîñòåé Ðåâìàòîëî㳿
òà Ðåàá³ë³òàö³¿ (ðàí³øå Ô³çè÷íà Ìåäèöèíà), â äðó-
ãèõ – ç ðîçâèòêîì ³ç Áàëüíåîëî㳿, à â ³íøèõ – ç
âèíèêíåííÿ de novo1. Ñòèìóë äëÿ öüîãî ñòâîðåííÿ
âèíèê ãîëîâíèì ÷èíîì ï³ñëÿ Äðóãî¿ ñâ³òîâî¿ â³éíè
³ åï³äåì³é ïîë³î쳺ë³òó, âíàñë³äîê ÷îãî âåëèêà
71
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ê³ëüê³ñòü ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³
ïîòðåáóâàëà ô³çè÷íî¿ òà íåô³çè÷íî¿ ìåäè÷íî¿ äî-
ïîìîãè, âêëþ÷àþ÷è ñüîãîäí³ óâàãó äî á³æåíö³â òà
îñ³á ï³ñëÿ æîðñòîêîãî â³äíîøåííÿ, ùî º äâèãóíà-
ìè ö³º¿ ñïåö³àëüíîñò³. Äîäàòêîâèé ïîøòîâõ â äà-
íîìó íàïðÿìêó íàäàëè çá³ëüøåííÿ ³ ïîë³ïøåííÿ
ìåäèêî-õ³ðóðã³÷íèõ ìåòîä³â ë³êóâàííÿ ïðîòÿãîì
îñòàííüîãî òà ïîòî÷íîãî ñòîë³òü, à òàêîæ ðîçâè-
òîê îðòîïåäè÷íîãî ë³êóâàííÿ, çá³ëüøåííÿ òðèâà-
ëîñò³ æèòòÿ íàñåëåííÿ, ñïîðòèâí³ òðàâìè òîùî1.
Ç ³íøîãî áîêó, íà îñíîâ³ ðîáîò Still òà Palmer,
ÿê çãàäóâàëîñÿ ðàí³øå, â³äîì³ ë³êàð³, òàê³ ÿê James
Cyriax òà Leon Chaitow (Âåëèêà Áðèòàí³ÿ) 9-11 ,
Robert Maigne (Ôðàíö³ÿ)12, Vladimir Janda òà Karel
Lewitt (â êîëèøí³é ×åõîñëîâà÷÷èí³)13-15, òà ³íø³,
ñòâîðèëè ð³çí³ ºâðîïåéñüê³ øêîëè îðòîïåäè÷íî¿ òà
ìàíóàëüíî¿ ìåäèöèíè. Òàêèì ÷èíîì, ñïðèÿííÿ âè-
êîðèñòàííþ ìàíóàëüíèõ çàñîá³â îö³íþâàííÿ, ä³àã-
íîñòèêè òà ë³êóâàííÿ, ÿê ðîáî÷èõ ³íñòðóìåíò³â âè-
ñîêî ö³íóºòüñÿ ³ ïðàêòèêóºòüñÿ ñüîãîäí³ ë³êàðÿìè
ö³º¿ ñïåö³àëüíîñò³, òà îñîáëèâî âèêîðèñòîâóºòüñÿ
ïðè ì’ÿçîâî-ñêåëåòíèõ ðîçëàäàõ16.
Òàêîæ â³äêðèòòÿ ³ñíóâàííÿ íåéðîïëàñòè÷íîñò³
äîçâîëèëî áàãàòüîì ïàö³ºíòàì, ùî ñòðàæäàþòü â³ä
çàõâîðþâàíü öåíòðàëüíî¿ íåðâîâî¿ ñèñòåìè
(³íñóëüò, öåðåáðàëüíèé ïàðàë³÷, ÷åðåïíî-ìîçêîâ³
òðàâìè òîùî), ÿê³ ðàí³øå íå ðîçãëÿäàëèñÿ äëÿ ðå-
àá³ë³òàö³¿, ë³êóâàòèñÿ çà äîïîìîãîþ òåðàïåâòè÷íèõ
âïðàâ17.
Á³ëüø òîãî, â³äêðèòòÿ íîâèõ ìåòîä³â ô³çè÷íîãî
ë³êóâàííÿ, ä³àãíîñòè÷íèõ òà äîñë³äíèöüêèõ ìî-
äàëüíîñòåé, òàêèõ ÿê: åêñòðàêîðïîðàëüíà óäàðíî-
õâèëüîâà òåðàï³ÿ18,19, ëàáîðàòî𳿠õîäüáè, ðîáîòè,
â³ðòóàëüíà ðåàëüí³ñòü20, óëüòðàçâóêîâà ä³àãíîñòè-
êà òà ñó÷àñí³ ìåòîäè íåéðîâ³çóàë³çàö³¿, ì³æ ³íøè-
ìè, âåäóòü öþ ñïåö³àëüí³ñòü äî íèí³øíüî¿ ñó÷àñ-
íî¿ êîíöåïö³¿.
Âñå öå ïîºäíóºòüñÿ ç ìàéáóòíüîþ ðåôîðìîþ
íàâ÷àëüíèõ ïðîãðàì ç ÔÐÌ íà ºâðîïåéñüêîìó òà
íàö³îíàëüíîìó ð³âíÿõ.
Ñïåö³àëüí³ñòü ÔÐÌ ìàëà âåëèêèé ðîçâèòîê
êë³í³÷íî¿ ïðàêòèêè, ïóáë³êàö³é, çóñòð³÷åé ³ îñâ³òè,
çàñíîâàíèõ íà îáì³í³ äîñâ³äîì ³ ïåðñïåêòèâàìè
ë³êàðåíü ³ ðåàá³ë³òàö³éíèõ öåíòð³â ïðàêòè÷íî ó âñ³õ
ºâðîïåéñüêèõ êðà¿íàõ. Âñ³ ö³ ïðîöåäóðè âèêîíóþòü-
ñÿ äëÿ ïàö³ºíò³â óñ³õ â³êîâèõ ãðóï, à òàêîæ ç îãëÿ-
äó íà ñîö³àëüíî-êóëüòóðí³ òà åòè÷í³ ïèòàííÿ, çî-
ñåðåäæóþ÷èñü íà ãëîáàëüíîìó â³äíîâëåíí³ â
íàïðÿìêó ïîâíî¿ íåçàëåæíîñò³. Òåðì³í, ÿêèé äåìîí-
ñòðóº òàêèé øèðîêèé ðîçâèòîê – “³íäèâ³äóàëüíèé
ïîòåíö³àë â³äíîâëåííÿ” – â³äîáðàæຠîñíîâí³ äæå-
ðåëà òà ê³íöåâ³ ö³ë³ ðåàá³ë³òàö³¿.
Áåðó÷è äî óâàãè öþ ³ñòîð³þ çàãàëüíîãî òà, îä-
íî÷àñíî, ð³çíîìàí³òíîãî ðîçâèòêó, ÷óäîâî, ùî çà-
ðàç â ªâðîï³ ³ñíóº ºäèíå âèçíà÷åííÿ ñïåö³àëüíîñò³,
72 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÿêå óçãîäæóºòüñÿ ç ì³æíàðîäíî âèçíàíèì îïèñîì
ÔÐÌ (íà îñíîâ³ ìîäåë³ ÌÊÔ)21. Íèí³øíÿ çàãàëü-
íà ìåòà ñïåö³àëüíîñò³ çîñåðåäæóºòüñÿ íà áàãàòüîõ
ð³çíèõ ³íòåðâåíö³ÿõ, íåîáõ³äíèõ äëÿ äîñÿãíåííÿ
ìàêñèìàëüíî ìîæëèâîãî ð³âíÿ ôóíêö³îíàëüíî¿
åôåêòèâíîñò³ òà ó÷àñò³ çàëåæíî â³ä êîíòåêñòó ³
áàæàííÿ ëþäèíè.
²ñòîð³ÿ òà ðîçâèòîê îðãàí³çàö³é ÔÐÌ
â ªâðîï³
ßê çãàäóâàëîñÿ ðàí³øå, ï³ñëÿ Äðóãî¿ ñâ³òîâî¿
â³éíè, ³äåÿ ðîçðîáêè êîíêðåòíî¿ ïîë³òèêè â ãàëóç³
ðåàá³ë³òàö³éíî¿ ìåäèöèíè ñòàëà ç’ÿâëÿòèñÿ â óñüî-
ìó ñâ³òîâ³ ³, îñîáëèâî, â ªâðîï³. ²äåÿ íîâî¿ ìåäè÷-
íî¿ ñïåö³àëüíîñò³ ïî÷àëà ðåàë³çîâóâàòèñÿ øëÿõîì
çàñíóâàííÿ íàö³îíàëüíèõ íàóêîâèõ òîâàðèñòâ1.
Çà ³í³ö³àòèâîþ 10 òðàâíÿ 1950 ðîêó â Ëîíäîí³
íàðîäèâñÿ ïðîåêò ñòâîðåííÿ International
Federation of Physical Medicine. Öÿ îðãàí³çàö³ÿ ïî-
âèííà áóëà îá’ºäíóâàòè íàö³îíàëüí³ íàóêîâ³ òîâà-
ðèñòâà â ãàëóç³ ô³çè÷íî¿ ìåäèöèíè â óñüîìó ñâ³ò³.
Ïåðøèé Êîíãðåñ International Federation of Physical
Medicine (ï³çí³øå ïåðåéìåíîâàíèé â International
Federation of Physical Medicine and Rehabilitation)
â³äáóâñÿ â Ëîíäîí³ â 1952 ðîö³. Ïåðø³ òðè êîíãðå-
ñè, ùî áóëè ïðîâåäåí³ â ªâðîï³ (1956 – Êîïåíãà-
ãåí, 1964 – Ïàðèæ, 1972 – Áàðñåëîíà), ñïðèÿëè
êðèñòàë³çàö³¿ âóçëà ºâðîïåéñüêèõ ë³êàð³â, îá’ºäíà-
íèõ ºäèíîþ ìåòîþ ñòâîðåííÿ ñïåö³àëüíîñò³ â
ªâðîï³.
Ö³êàâî â³äçíà÷èòè, ùî ô³çè÷íà ³ ðåàá³ë³òàö³éíà
ìåäèöèíà (ÔÐÌ) â ªâðîï³ ïî÷àëà îðãàí³çîâóâàòè-
ñÿ â ðîêè òðóäîì³ñòêîãî íàðîäæåííÿ âåëèêèõ ïîë³-
òè÷íèõ ºâðîïåéñüêèõ îðãàí³çàö³é, Ðàäè ªâðîïè â
1949 ðîö³, à ïîò³ì ªâðîïåéñüêî¿ åêîíîì³÷íî¿
ñï³ëüíîòè (Áåëüã³ÿ, Ôðàíö³ÿ, ͳìå÷÷èíà, ²òàë³ÿ,
Ëþêñåìáóðã, ͳäåðëàíäè) çã³äíî äî Ðèìñüêî¿ Óãî-
äè â 1957 ðîö³. Òàêèì ÷èíîì, ñïåö³àëüí³ñòü ÔÐÌ
â ªâðîï³ çíàéøëà ñâîþ ñèëó ³ äóõ íà çàñàäàõ ºâðî-
ïåéñüêîãî äóõó22.
Ç 1950-õ ïî 1970-ò³ ðîêè ðÿä ë³êàð³â ç ð³çíèõ
ºâðîïåéñüêèõ êðà¿í, îá’ºäíàíèõ îäíèìè ³ òèìè æ
ðîçóìîì, äóõîì ³ âîëåþ ðóõàòèñü âïåðåä, ïðàöþ-
âàëè ùîá äåòàëüíî âèçíà÷èòè, ðîçâèíóòè ³ çðîáè-
òè àâòîíîìíîþ íîâó ñïåö³àëüí³ñòü, ÿêà â òó ïîðó
áóëà àí³ â³äîìîþ, àí³ âèçíà÷åíîþ.
Ðåçóëüòàòîì ¿õ ðîáîòè áóëî ñòâîðåííÿ ÷îòè-
ðüîõ ªâðîïåéñüêèõ Îðãàí³çàö³é, ÿê³, çá³ëüøóþ÷èñü
³ ïîñèëþþ÷è ñâîþ âëàñíó ä³ÿëüí³ñòü, â ðåçóëüòàò³
çàñíóâàëè íîâó àâòîíîìíó ñïåö³àëüí³ñòü ó âñ³õ
ºâðîïåéñüêèõ êðà¿íàõ. Ö³ ÷îòèðè îðãàí³çàö³¿ áóëè
ñòâîðåí³ â íàñòóïíîìó õðîíîëîã³÷íîìó ïîðÿäêó: ó
1963 ð. – ªâðîïåéñüêà ôåäåðàö³ÿ ô³çè÷íî¿ ìåäèöè-
íè òà ðåàá³ë³òàö³¿; â 1969 ð. – Acad mie M dicale
¹2(2) *2018

Europ enne de M decine de R adaptation; à â 1971
ðîö³ – Ñåêö³ÿ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷-
íèõ Ñïåö³àë³ñò³â (ªÑÌÑ), à â 1991 ðîö³ – ªâðî-
ïåéñüêèé Êîëåäæ ÔÐÌ.
Çàñíîâíèêè îðãàí³çàö³é ³ ò³, õòî ïðîòÿãîì áàãà-
òüîõ ðîê³â ïðèñâÿòèâ ñåáå ðîáîò³ â ðàìêàõ îðãàí³-
çàö³é (à òàêîæ ëþäè, ùî ïðàöþâàëè çàðàäè ö³º¿ æ
ìåòè, â íå¿ ï³çí³øå), ââàæàëèñÿ ïåðåêîíàíèìè
“ºâðîïåéöÿìè”, à òàêîæ áà÷èëè, ùî ¿õíÿ ì³ñ³ÿ ³íòåã-
ðîâàíà â ðîçâèòîê ºâðîïåéñüêî¿ ñï³ëüíîòè.
ªâðîïåéñüêå òîâàðèñòâî ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ªÒÔÐÌ)
ªâðîïåéñüêà Ôåäåðàö³ÿ Ô³çè÷íî¿ Ìåäèöèíè òà
Ðåàá³ë³òàö³¿ (EFPMR) ïåðåòâîðèëàñÿ íà ªâðî-
ïåéñüêå òîâàðèñòâî ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè (ªÒÔÐÌ).
Îô³ö³éíå íàðîäæåííÿ ªâðîïåéñüêî¿ ôåäåðàö³¿
ô³çè÷íî¿ ìåäèöèíè òà ðåàá³ë³òàö³¿ (EFPMR),
(F d ration Europ enne de M decine Physique and
R adaptation, ÿê íàïèñàíî ôðàíöóçüêîþ ìîâîþ ó
Áåëü㳿) â³äáóëîñÿ 25 êâ³òíÿ 1963 ðîêó, ÿê îïóáë³-
êîâàíî â Îô³ö³éíîìó æóðíàë³ Êîðîë³âñòâà Áåëüã³ÿ.
Ôåäåðàö³ÿ áóëà îðãàí³çàö³ºþ ç íàóêîâîþ ìåòîþ,
ùî îá’ºäíóâàëà íàö³îíàëüí³ íàóêîâ³ òîâàðèñòâà.
Íàì³ðè ö³º¿ ôåäåðàö³¿ áóëè, ïî ñóò³, íàóêîâèìè.
Âîíà ïîñòàâèëà ïåðåä ñîáîþ íàñòóïí³ ö³ë³:
1. Îðãàí³çàö³ÿ íàóêîâî¿ ñï³âïðàö³ ç ìåòîþ ðîç-
âèòêó ÔÐÌ;
2. Ãàðìîí³çàö³ÿ â ºâðîïåéñüêèõ êðà¿íàõ ÿê íà-
â÷àííÿ ñïåö³àë³ñò³â, òàê ³ êâàë³ô³êàö³éíèõ êðèòåð³¿â
ó ðåàá³ë³òàö³éí³é ìåäèöèí³;
3. Ïðîñóâàííÿ â êîæí³é ºâðîïåéñüê³é êðà¿í³ íà-
ö³îíàëüíîãî íàóêîâîãî òîâàðèñòâà ç ÔÐÌ òà òåî-
ðåòè÷íî¿ îðãàí³çàö³¿ äëÿ çàõèñòó çàãàëüíèõ ³íòå-
ðåñ³â ë³êàðÿ ÔÐÌ;
4. Ãàðìîí³çàö³ÿ íà ì³æíàðîäíîìó ð³âí³ ä³é, âæè-
òèõ ð³çíèìè îðãàí³çàö³ÿìè, òà ïðåäñòàâíèöòâî ñïåö³-
àë³çàö³¿ ÔÐÌ ó ð³çíèõ ºâðîïåéñüêèõ îðãàíàõ âëàäè.
Ç ñàìîãî ïî÷àòêó ì³ñ³ÿ EFPMR áóëà ñïðÿìî-
âàíà íà ñïðèÿííÿ íàâ÷àííÿ ôàõ³âö³â ÔÐÌ, çàïî÷àò-
êóâàâøè “etudes commission” (êîì³ñ³þ ïî íàâ÷àííþ).
Öÿ êîì³ñ³ÿ, ï³ñëÿ âèâ÷åííÿ ñèòóàö³¿ ç âèêëàäàí-
íÿì ó ð³çíèõ ºâðîïåéñüêèõ êðà¿íàõ, ï³äãîòóâàëà
ïðîåêò äîêóìåíòà “Íàâ÷àííÿ ñïåö³àë³ñò³â â
ªâðîï³”. ³í áóâ ïðåäñòàâëåíèé íà V Êîíãðåñ³
̳æíàðîäíî¿ ôåäåðàö³¿ â Ìîíðåàë³. Ó 1970 ð. öåé
çâ³ò áóâ ðîçãëÿíóòèé ªâðîïåéñüêèì ðåã³îíàëüíèì
áþðî Âñåñâ³òíüî¿ îðãàí³çàö³¿ îõîðîíè çäîðîâ’ÿ, ÿê
êîðèñíèé äîâ³äêîâèé äîêóìåíò äëÿ ðîçðîáêè ïðî-
ãðàìè êîíôåðåíö³¿ “Âèêëàäàííÿ ìåäè÷íî¿ ðåàá³ë³-
òàö³¿”, ÿêà â³äáóëàñÿ ó Ïîëüù³ 10-16 ëèñòîïàäà
1971 ðîêó. Íà ö³é êîíôåðåíö³¿ áóëî âñòàíîâëåíî, ùî
â³äïîâ³äàëüí³ñòü ïðàêòèê³â ðåàá³ë³òàö³éíî¿ ìåäèöè-
íè ïîëÿãຠâ òîìó, ùîá çàëèøèòè åêñïåðòèçó
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 4 – ²ÑÒÎÐ²ß ÑÏÅÖ²ÀËÜÍÎÑÒ²: DzÄÊÈ ÏÎÕÎÄÈÒÜ ÔÐÌ
“ñïåö³àëüíî” íàâ÷åíîìó ñïåö³àë³ñòîâ³, à í³ ñïåö³à-
ë³ñòàì ³íøèõ äèñöèïë³í.
Öåé âèá³ð áóâ âèð³øàëüíèì, îñê³ëüêè ñïî÷àòêó
÷ëåíè íàö³îíàëüíèõ òîâàðèñòâ ïðèõîäèëè ç ð³çíèõ
â³äïîâ³äíèõ ñïåö³àëüíîñòåé (îðòîïåä³ÿ, íåâðîëîã³ÿ,
ðåâìàòîëîã³ÿ, ðàä³îëîã³ÿ òîùî), äèñöèïë³íà íàçè-
âàëàñÿ ð³çíèìè íàçâàìè, ³ ïðàêòèêà, çäàâàëîñÿ,
áóëà ð³çíîþ â óñ³õ ºâðîïåéñüêèõ ðåã³îíàõ. Îòæå, â
öåé ÷àñ, êîëè ñïåö³àëüí³ñòü íå ³ñíóâàëà â æîäí³é
ºâðîïåéñüê³é êðà¿í³, Ôåäåðàö³ÿ ñòâîðèëà óìîâè äëÿ
âèíèêíåííÿ òà êîíêðåòèçàö³¿ íîâî¿ ñïåö³àëüíîñò³ òà
äëÿ çàõèñòó ¿¿ ïðàêòèêóþ÷èõ ë³êàð³â23.
EFPMR áóëà ïðåäñòàâëåíà â ÿêîñò³ íåóðÿäîâî¿
îðãàí³çàö³¿ ïðè Ðàä³ ªâðîïè øëÿõîì ðîçðîáêè äåÿ-
êèìè ÷ëåíàìè åêñïåðò³â âàæëèâîãî äîêóìåíòà,
îïóáë³êîâàíîãî â 1984 ðîö³, ç íàçâîþ “Ïîñë³äîâíà
ïîë³òèêà ðåàá³ë³òàö³¿ ëþäåé ç îáìåæåííÿìè æèò-
òºä³ÿëüíîñò³ – ï³äãîòîâêà ïåðñîíàëó îõîðîíè çäî-
ðîâ’ÿ, ùî ïðàöþº ó ñôåð³ ðåàá³ë³òàö³¿: ïîòî÷íà ñè-
òóàö³ÿ â äåðæàâàõ-÷ëåíàõ òà ïðîïîçèö³¿ ùîäî
âäîñêîíàëåííÿ öüîãî âèäó ï³äãîòîâêè”.
EFPMR ïî÷àëà îðãàí³çîâóâàòè íàóêîâ³ çóñòð³÷³,
ÿê³ ìàëè ôîðìó ºâðîïåéñüêèõ êîíãðåñ³â, ÿê³ ïðîòÿ-
ãîì áàãàòüîõ ðîê³â ïðîâîäèëèñü ùîäâîð³÷íî. Êð³ì
òîãî, ç 1964 ðîêó ïîøèðþâàâñÿ íàóêîâèé æóðíàë
“Europa Medicophysica” (²òàë³ÿ). Öåé ³íäåêñîâàíèé
îãëÿä, â³äîìèé çàðàç, ÿê European Journal of Physical
and Rehabilitation Medicine, º âàæëèâèì ³íñòðóìåí-
òîì äëÿ ðîçâèòêó äîñë³äæåíü ç ÔÐÌ â ªâðîï³.
Ó 2003 ðîö³ ªâðîïåéñüêà ôåäåðàö³ÿ ÔÐÌ, ÿêà
âíåñëà òàêèé çíà÷íèé âíåñîê ó ñòâîðåííÿ ³ îäíî-
ð³äíèé ðîçâèòîê íàøî¿ äèñöèïë³íè, áóëà ðîçïóùå-
íà, ùîá çâ³ëüíèòè ì³ñöå äëÿ ñòâîðåííÿ ºâðîïåéñü-
êîãî íàóêîâîãî òîâàðèñòâà, ªâðîïåéñüêîãî
Òîâàðèñòâà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöè-
íè (ªÒÔÐÌ), ÷ëåíñòâî ó ÿêîìó â³äêðèòî òàêîæ
äëÿ ³íäèâ³äóàëüíèõ ÷ëåí³â, ùî ñïåö³àë³çóþòüñÿ â
ÔÐÌ, õî÷à ó÷àñòü íàö³îíàëüíèõ òîâàðèñòâ çàëè-
øàºòüñÿ éîãî öåíòðàëüíèì åëåìåíòîì. Öå òîâà-
ðèñòâî âñòàíîâèëî ìåòó ðîçâèâàòè á³ëüøó îä-
íîð³äí³ñòü ç íàóêîâî¿ òà ïðîôåñ³éíî¿ òî÷êè çîðó.
Íàö³îíàëüí³ òîâàðèñòâà (ÿêèõ ó 1963 ðîö³ áóëî
ëèøå 5) ó 2003 ðîö³ äîñÿãëè ê³ëüêîñò³ 20 (Àâñòð³ÿ,
Áåëüã³ÿ, Áîëãàð³ÿ, Õîðâàò³ÿ, ʳïð, Ôðàíö³ÿ, ͳìå÷÷è-
íà, Ãðåö³ÿ, ²òàë³ÿ, Ëàòâ³ÿ, Ëèòâà, ͳäåðëàíäè, Ïîð-
òóãàë³ÿ, Ðóìóí³ÿ, Ñåðá³ÿ, Ñëîâåí³ÿ, ²ñïàí³ÿ, Øâåé-
öàð³ÿ, Òóðå÷÷èíà òà Âåëèêà Áðèòàí³ÿ). Ó öåé ïåð³îä
ÔÐÌ ñèëüíî çáàãàòèëà ñâîþ ðîëü ó âñ³é ªâðîï³,
íàðîùóþ÷è â³äïîâ³äàëüí³ñòü â ñëóæáàõ îõîðîíè
çäîðîâ’ÿ â áàãàòüîõ êðà¿íàõ (íà æàëü, ç äåÿêèìè
â³äì³ííîñòÿìè â îñâ³òí³é ³ ïðîôåñ³éí³é îáëàñòÿõ) ³
òàêîæ îòðèìóþ÷è ïåâí³ âèçíàííÿ â³ä ºâðîïåéñüêèõ
îðãàí³â.
̳ñ³ÿ ªÒÔÐÌ: à) áóòè ïðîâ³äíèì íàóêîâèì ºâðî-
ïåéñüêèì òîâàðèñòâîì ë³êàð³â â îáëàñò³ ô³çè÷íî¿ òà
73
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ðåàá³ë³òàö³éíî¿ ìåäèöèíè; á) óäîñêîíàëþâàòè çíàííÿ
ïðî îñíîâè ³ óïðàâë³ííÿ àêòèâí³ñòþ, ó÷àñòþ ³ êîí-
òåêñòóàëüíèìè ôàêòîðàìè ëþäåé, ÿê³ çàçíàþòü àáî
ìîæóòü çàçíàòè îáìåæåíü æèòòºä³ÿëüíîñò³ òà
â) ïîë³ïøèòè ³ ï³äòðèìóâàòè ì³öíèé çâ’ÿçîê ì³æ äî-
ñë³äæåííÿìè ³ êë³í³÷íîþ ïðàêòèêîþ ÔÐÌ.
Acad mie M dicale Europ enne de M decine
de R adaptation / ªâðîïåéñüêà Àêàäåì³ÿ
Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ)
Ó 1968 ðîö³ â õîä³ ï³äãîòîâêè 5-ãî Êîíãðåñó
̳æíàðîäíî¿ ôåäåðàö³¿ áóëî â³äçíà÷åíî, ùî êîëå-
ãè ç ð³çíèõ êðà¿í, ÿê³ ïðàöþþòü äëÿ ñïåö³àëüíîñò³,
çàíàäòî ÷àñòî çì³íþþòüñÿ. Òàêîæ áóëî â³äçíà÷å-
íî, ùî æîäíà ç ö³ëåé Ôåäåðàö³¿ íå áóëà ñïðÿìîâà-
íà íà ô³ëîñîô³þ ðåàá³ë³òàö³éíî¿ ìåäèöèíè. Òàêèì
÷èíîì, áóëî âèð³øåíî ñòâîðèòè Àêàäåì³þ, ùî
ñêëàäàºòüñÿ ç ëþäåé, äîáðå â³äîìèõ â îáëàñò³
ðåàá³ë³òàö³éíî¿ ìåäèöèíè, ç ìåòîþ çàïî÷àòêóâàí-
íÿ îðãàí³çàö³¿, äå ÷ëåíè áóäóòü çíàõîäèòüñÿ òðè-
âàëèé ÷àñ òà áóäóòü, ãîëîâíèì ÷èíîì, çàéìàòèñÿ
ô³ëîñîôñüêèìè ³ åòè÷íèìè àñïåêòàìè ðåàá³ë³òà-
ö³éíî¿ ìåäèöèíè, à òàêîæ ï³äòðèìóâàòè íàóêîâèé
ðîçâèòîê ñïåö³àëüíîñò³. Àêàäåì³ÿ áóëà çàñíîâàíà
â Æåíåâ³ â 1969 ðîö³ â³ñüìîìà ÷ëåíàìè-çàñíîâíè-
êàìè ï³ä íàçâîþ Acad mie M dicale Europ enne de
M decine de R adaptation. Öå ³ì’ÿ áóëî çì³íåíî â
1996 ðîö³ íà Acad mie Europ enne de M decine de
R adaptation /ªâðîïåéñüêà àêàäåì³ÿ ðåàá³ë³òàö³é-
íî¿ ìåäèöèíè.
Þðèäè÷íîþ àäðåñîþ Àêàäå쳿 º Áðþññåëü. ¯¿
ëîãî – «Societatis vir origo ac finis» (Ëþäèíà – öå
äæåðåëî ³ ìåòà ñóñï³ëüñòâà). ¯¿ îô³ö³éíà ìîâà áóëà
ôðàíöóçüêîþ, àëå îñòàíí³ì ÷àñîì ÿê ôðàíöóçüêà,
òàê ³ àíãë³éñüêà áóëè îãîëîøåí³ îô³ö³éíèìè ìîâàìè,
ç á³ëüø øèðîêèì âèêîðèñòàííÿì àíãë³éñüêî¿ ìîâè.
Ìåòîþ Àêàäå쳿 º âäîñêîíàëåííÿ âñ³õ íà-
ïðÿìê³â ðåàá³ë³òàö³¿ íà êîðèñòü òèõ, õòî ¿¿ ïîòðå-
áóº. Òàêèì ÷èíîì, âîíà ñïðèÿº íàâ÷àííþ ³ äîñë³ä-
æåííÿì â ªâðîï³, âèñòóïàþ÷è â ÿêîñò³ äîâ³äêîâî¿
òî÷êè â íàóêîâèõ, îñâ³òí³õ ³ äîñë³äíèöüêèõ ïèòàí-
íÿõ, îáì³í³ ³äåÿìè òà ³íôîðìàö³ºþ, ñïðèÿþ÷è îá-
ì³íó ë³êàðÿìè ÔÐÌ ì³æ ð³çíèìè êðà¿íàìè ³ çàéìà-
þ÷èñü ìîðàëüíèìè ³ åòè÷íèìè äåáàòàìè. ªÀÐÌ
ñêëàäàºòüñÿ ç ëþäåé, ÿê³ º â³äîìèìè ó ºâðîïåéñü-
êîìó ñâ³ò³ ðåàá³ë³òàö³éíî¿ ìåäèöèíè. Âîíè ïîâèíí³
áóòè ë³êàðÿìè, ùî ñïåö³àë³çóþòüñÿ â ðåàá³ë³-
òàö³éí³é ìåäèöèí³, ÿê³ îñîáëèâî âèä³ëÿþòüñÿ ó ö³é
ãàëóç³ íå ò³ëüêè ç òåõí³÷íî¿ ÷è íàóêîâî¿ òî÷êè çîðó,
àëå òàêîæ ³ ¿õ ãóìàí³ñòè÷íèì ï³äõîäîì. Âîíè ïî-
õîäÿòü ç á³ëüøîñò³ ºâðîïåéñüêèõ êðà¿í, ³ çàðàç ÷ëåí-
ñòâî ïðîäîâæóº ðîçøèðþâàòèñÿ íà ñõ³ä. Ìàêñè-
ìàëüíà ê³ëüê³ñòü ó÷àñíèê³â – 50, àëå âîíà í³êîëè
íå ïåðåâèùóâàëà 40, òîä³ ÿê ïîòî÷íå ÷èñëî – 35.
Âîíè âèáèðàþòüñÿ çà çàïðîøåííÿì, îáèðàþòüñÿ
74 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ëèøå òàºìíèì ãîëîñóâàííÿì, ï³ñëÿ ñêëàäíî¿ ïðî-
öåäóðè, ÿêà ïåðåäáà÷ຠïîäàííÿ òðüîìà ÷ëåíàìè
Àêàäå쳿. ªÀÐÌ, õî÷à ³ ìຠàâòîíîìíó ïðîãðàìó
ä³ÿëüíîñò³, ò³ñíî ñï³âïðàöþº ç ªÒÔÐÌ, à òàêîæ ç
Ñåêö³ºþ òà Ðàäîþ ÔÐÌ ªÑÌÑ.  ðåçóëüòàò³ ö³º¿
ñï³âïðàö³ ïåðøå âèäàííÿ Á³ëî¿ Êíèãè ç ô³çè÷íî¿ òà
ðåàá³ë³òàö³éíî¿ ìåäèöèíè áóëî îïóáë³êîâàíî â 1989
ðîö³. Öÿ êíèãà áóëà íàïèñàíà íà ÷îòèðüîõ ìîâàõ
(³ñïàíñüêà, àíãë³éñüêà, ôðàíöóçüêà, ³òàë³éñüêà), à
ïîò³ì ïåðåâèäàíà â ð³çíèõ êðà¿íàõ. Äðóãå âèäàííÿ
ªâðîïåéñüêî¿ Á³ëî¿ Êíèãè ç ô³çè÷íî¿ òà ðåàá³ë³òà-
ö³éíî¿ ìåäèöèíè áóëî îïóáë³êîâàíî â 2006 ðîö³.
Ïðîòÿãîì îñòàíí³õ ðîê³â áóëî îïóáë³êîâàíî ðÿä
äîêóìåíò³â, ñåðåä ÿêèõ:
– ²íàâãóðàö³éí³ ëåêö³¿ àêàäåì³ê³â, îïóáë³êîâàí³ â
“Europa Medicophysica” (Minerva Medica, Òóðèí,
Ðèì, ̳ëàí). M decine de R ducation et R adap-
tation, 235ñ., Documenta Geigy, Ïàðèæ, 1982.
– Áàãàòî åòè÷íèõ äîêóìåíò³â áóëî ï³äãîòîâëåíî
ï³ä ïàòðîíàòîì Àêàäå쳿, íàéâàæëèâ³øèì ââà-
æàºòüñÿ «Äîñòóïí³ñòü â ðåàá³ë³òàö³¿ îñ³á ç îá-
ìåæåííÿìè æèòòºä³ÿëüíîñò³».
Ñåêö³ÿ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó
Ìåäè÷íèõ Ñïåö³àë³ñò³â (ªÑÌÑ)
³ëüíå ïåðåì³ùåííÿ ë³êàð³â ì³æ ø³ñòüìà ð³çíè-
ìè êðà¿íàìè ªâðîïåéñüêîãî ñï³âòîâàðèñòâà (1957)
çðîáèëî íåîáõ³äíèì ãàðìîí³çàö³þ îñâ³òè ³ êâàë³ô³-
êàö³¿ ñïåö³àë³ñò³â, çàäëÿ òîãî, ùîá îòðèìàòè ÿê³ñòü
íàäàííÿ äîïîìîãè íà îäíàêîâîìó îïòèìàëüíîìó
ð³âí³ â êîæí³é ºâðîïåéñüê³é êðà¿í³. Öå áóëà ìåòà
ªÑÌÑ, ÿêèé áóâ çàñíîâàíèé â ëèïí³ 1958 ðîêó â
Áðþññåë³. ªÑÌÑ ç ñàìîãî ïî÷àòêó ï³äòðèìóâàâ
ò³ñí³ êîíòàêòè ç îô³ö³éíèìè ñòðóêòóðàìè ªâðîïåéñü-
êîãî Ñîþçó òà Ðàäîþ ªâðîïè. Ó íàñòóïí³ ðîêè áóëè
ïîñòóïîâî çàñíîâàí³ ñåêö³¿ çà ñïåö³àëüíîñòÿìè24.
Ñåêö³ÿ “Physiotherapie/Ô³ç³îòåðàï³ÿ” áóëà çàñ-
íîâàíà â 1963 ðîö³, àëå ¿¿ ïåðøà ñàìîñò³éíà çóñòð³÷
â³äáóëàñÿ â 1971 ðîö³ (Mondorf les Bains, Ëþêñåì-
áóðã). Íà ö³é çóñòð³÷³ äåÿê³ ³ñòîðè÷í³ ä³ÿ÷³ ³ äåëå-
ãàòè ³ç çàêîííèìè ïîâíîâàæåííÿìè, çà äîïîìîãîþ
þðèñò³â ªÑÌÑ, çàòâåðäèëè àâòîíîì³þ ñïåö³àëü-
íîñò³ ³ çàïðîïîíóâàëè çì³íèòè ¿¿ íàçâó íà “Ô³çè÷íà
Ìåäèöèíà òà Ðåàá³ë³òàö³ÿ” (çãîäîì öå ³ì’ÿ áóëî
çì³íåíå íà “Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäè-
öèíà”)25.
Ç ìîìåíòó ñòâîðåííÿ Ñåêö³¿ ³ ïðàêòè÷íî äî ê³íöÿ
ÕÕ ñòîë³òòÿ ñïåö³àëüí³ñòü ùå íå áóëà îäíàêîâîþ
â ð³çíèõ êðà¿íàõ. Ïîòð³áíî áóëî âèð³øèòè òàê³ îñ-
íîâí³ ïðîáëåìè:
– âñòàíîâèòè âèçíà÷åííÿ ñïåö³àëüíîñò³, òî÷íå òà
îô³ö³éíå;
– íàäàòè îäíàêîâó íàçâó äëÿ ö³º¿ ñïåö³àëüíîñò³ ó
âñ³õ êðà¿íàõ ªâðîïåéñüêîãî ñï³âòîâàðèñòâà òà
ªâðîïè;
¹2(2) *2018

– âèçíà÷èòè ðîëü ë³êàðÿ, ùî ñïåö³àë³çóºòüñÿ â ö³é
äèñöèïë³í³;
– äàòè äëÿ âñ³õ ºâðîïåéñüêèõ êðà¿í ðåêîìåíäàö³¿
ùîäî îïòèìàëüíî¿ òà ãàðìîí³éíî¿ îñâ³òè;
– âèâ÷èòè â êîæí³é êðà¿í³, ÿêà áåçïåðåðâíà ìåäè÷-
íà îñâ³òà (ÁMÎ) ³ñíóº çà ö³ºþ ñïåö³àëüí³ñòþ
³ ÿê âîíà ïðîâîäèòüñÿ;
– âñòàíîâèòè çðó÷íèé ³ îá´ðóíòîâàíèé çâ’ÿçîê ì³æ
ñïåö³àëüí³ñòþ ³ ë³êóâàëüíèìè ïðîôåñ³ÿìè â ðå-
àá³ë³òàö³¿;
– âèçíà÷èòè Ñôåðó êîìïåòåíòíîñòåé ë³êàð³â ÔÐÌ
òà çàõèñòèòè ³íòåðåñè ë³êàð³â ÔÐÌ, ùî ïðàêòè-
êóþòü â ªâðîï³;
– àêðåäèòóâàòè ÿê³ñòü ïðîãðàì êë³í³÷íî¿ äîïîìî-
ãè òà âèçíà÷èòè ºâðîïåéñüê³ ðåêîìåíäàö³¿ ç
ì³í³ìàëüíèõ âèìîã äî êë³í³÷íî¿ ïðàêòèêè.
Ö³ ð³çí³ ö³ë³ áóëè äîñÿãíóò³, á³ëüø-ìåíø, ïðîòÿ-
ãîì 40 ðîê³â. Íàâ³òü çàðàç äëÿ äåÿêèõ ç öèõ ö³ëåé
íåîáõ³äíî ïðîäîâæèòè ðîáîòó. ßê ïðèêëàä, ìîæ-
íà çãàäàòè ðîçðîáêó åëåêòðîííî¿ êíèãè ç ïèòàíü
ñôåðè êîìïåòåíòíîñòåé ë³êàð³â ÔÐÌ ªâðîïè (÷àñ-
òèíè I òà II) Êîì³òåòîì ïðîôåñ³éí³é ïðàêòèêè
(ÊÏÏ), ùî âõîäèòü äî Ñåêö³¿, à òàêîæ ïðîöåäóðè
ðîçâèòêó ñïåö³àëüíîñò³ ÔÐÌ, àáî ¿¿ âïðîâàäæåííÿ
â êðà¿íàõ ªâðîïåéñüêîãî êîíòèíåíòó, äå öÿ ñïå-
ö³àëüí³ñòü ùå íå âèçíà÷åíà, ÿê ïåðâèííà (íàïð.
Ðîñ³ÿ, Óêðà¿íà òîùî).
ªâðîïåéñüêèé Êîëåäæ Ô³çè÷íî¿
òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÊÔÐÌ)
(â îñîá³ Ðàäè ÔÐÌ ªÑÌÑ)
Ç 1990 ðîêó ÷ëåíè Ñåêö³¿ ïðèñâÿòèëè ñåáå ï³äãî-
òîâö³ ñòâîðåííÿ ªâðîïåéñüêîãî Êîëåäæó ÔÐÌ,
÷åòâåðòî¿ îðãàí³çàö³¿ ºâðîïåéñüêèõ ñïåö³àë³ñò³â.
Ñòàòóò Collåge Europeene de Medecine Physique et
de Readaptation áóâ çàðåºñòðîâàíèé 19 ëèïíÿ 1991
ðîêó ó ì. Ãààãà (ͳäåðëàíäè), â ì³ñö³ çíàõîäæåí-
íÿ ªâðîïåéñüêîãî ñóäó. Îñîáè- çàñíîâíèêè, ÿê³
ï³äïèñàëè ñòàòóò, áóëè ç ï’ÿòè ð³çíèõ êðà¿í: Áåëü㳿,
Ôðàíö³¿, Ïîðòóãà볿, ²ñïàí³¿ òà Ãîëëàí䳿. Ïðîòÿãîì
ðîê³â íàçâà öüîãî îðãàíó áóëà àäàïòîâàíà (àëå íå
çàðåºñòðîâàíà) ÿê ªâðîïåéñüêà Ðàäà ÔÐÌ. ³äíî-
ñèíè ì³æ Ðàäîþ òà Ñåêö³ºþ áóëè äóæå áëèçüêè-
ìè. Âëàñíå, Ðàäà âçÿëà íà ñåáå âñ³ îáîâ’ÿçêè
Ñåêö³¿ ç îñâ³òí³õ ñòîñóíê³â. Ãîëîâíîþ ìåòîþ Ðàäè
áóëà ãàðìîí³çàö³ÿ îñâ³òè òà íàâ÷àííÿ ôàõ³âö³â â
ð³çíèõ êðà¿íàõ íà íàéâèùîìó ìîæëèâîìó ð³âí³. Áóâ
ñòâîðåíèé âèêîíàâ÷èé êîì³òåò ³ç øåñòè ÷ëåí³â, òà
éîìó äîïîìàãàëà êîì³ñ³ÿ âèêëàäà÷³â, ùî ñêëàäà-
ëàñÿ ç ïðîôåñîð³â óí³âåðñèòåò³â.
3-4 ðàçè íà ð³ê ïðîâîäèëèñü ðîáî÷³ íàðàäè, íàé-
÷àñò³øå â Ïàðèæ³, äå çáèðàëèñÿ Âèêîíàâ÷èé êîì³-
òåò òà Îñâ³òí³é êîì³òåò. Ìåíø í³æ çà 2 ðîêè áóëè
ñòâîðåí³: íàâ÷àëüíà ïðîãðàìà ÔÐÌ, ñâîºð³äíà òå-
îðåòè÷íà ïðîãðàìà, ùî ñêëàäàºòüñÿ ç ðîçä³ë³â;
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 4 – ²ÑÒÎÐ²ß ÑÏÅÖ²ÀËÜÍÎÑÒ²: DzÄÊÈ ÏÎÕÎÄÈÒÜ ÔÐÌ
ìåòîäè ïðàêòè÷íîãî íàâ÷àííÿ; ïðàâèëà îòðèìàí-
íÿ òèòóëó ñåðòèô³êîâàíîãî Ðàäîþ çà åêâ³âàëåíòí³-
ñòþ; óìîâè ³ñïèòó; êðèòå𳿠àêðåäèòàö³¿ òðåíåð³â ³
íàâ÷àëüíèõ öåíòð³â ³ äâîìîâíèé àíãëî-ôðàíöóçü-
êèé æóðíàë äëÿ ðåºñòðàö³¿ íàâ÷àííÿ. Ó òîé æå ÷àñ
êîì³ñ³ÿ ïðàöþâàëà íàä ñòâîðåííÿì áàíêó äàíèõ
åêçàìåíàö³éíèõ ïèòàíü (ïèòàííÿ ç ìíîæèííèì âè-
áîðîì (MCQ) ³ êë³í³÷í³ âèïàäêè). Äëÿ ïåðøîãî
ªâðîïåéñüêîãî åêçàìåíó, ùî â³äáóâñÿ â Ãåíò³
(Áåëüã³ÿ) â 1993 ðîö³, áóâ ñòâîðåíèé àðõ³â ç á³ëüø
í³æ 500 ïèòàíü. Àíîí³ìí³ñòü òà îá’ºêòèâí³ñòü áóëè
êëþ÷îâèìè åëåìåíòàìè, ÿêèìè êåðóâàëèñÿ ï³ä ÷àñ
åêçàìåíàö³éíî¿ ïåðåâ³ðêè. Ç ö³º¿ äàòè áàíê MCQ
ñòàâ çíà÷íî áàãàòøèì, ³ ³ñïèò ïðîâîäèòüñÿ ùîðî-
êó â êîæí³é êðà¿í³ ç ïîñò³éíî çðîñòàþ÷îþ ê³ëüê³ñòþ
êàíäèäàò³â. Ç 2001 ðîêó áóëà ïðîâåäåíà ðåîðãàí³-
çàö³ÿ Ñåêö³¿ òà Ðàäè. Öÿ ðåîðãàí³çàö³ÿ áóëà íåîá-
õ³äíà, âðàõîâóþ÷è ðîáî÷å íàâàíòàæåííÿ êåð³âíèö-
òâà ö³º¿ ìåäè÷íî¿ ñïåö³àëüíîñò³, ùî çíàõîäèëàñü íà
åòàï³ ïîâíîãî ðîçâèòêó. Ó çâ’ÿçêó ç íåäàâíüîþ
ðåîðãàí³çàö³ºþ ªÑÌÑ áóëà âèð³øåíî ïðîäîâæèòè
ðîáîòó ÷åòâåðòî¿ îðãàí³çàö³¿ ªâðîïåéñüêèõ Îðãàí³â
ÔÐÌ ï³ä íàçâîþ ªâðîïåéñüêèé Êîëåäæ ÔÐÌ, ÿêà
áóäå âèêîíóâàòèñü Ðàäîþ ÔÐÌ ªÑÌÑ.
²ñòîð³ÿ òà ðîçâèòîê íàóêè ÔÐÌ â ªâðîï³.
ªâðîïåéñüê³ íàóêîâ³ æóðíàëè ç ÔÐÌ
Ðîçâèòîê íàóêè â ÔÐÌ ìàâ çìîãó ðîçâèâàòèñü
â äåê³ëüêîõ íàïðÿìêàõ. ÔÐÌ, ÿê íåçàëåæíà ìå-
äè÷íà ñïåö³àëüí³ñòü ìàéæå ó âñ³õ ºâðîïåéñüêèõ
êðà¿íàõ, íàé÷àñò³øå ðîçâèâàëàñü ï³ñëÿ Äðóãî¿
ñâ³òîâî¿ â³éíè ÿê ç á³îìåäè÷íî¿, òàê ³ ç êë³í³÷íî¿
÷àñòèí. Òàêèì ÷èíîì, êð³ì ë³êàð³â ÔÐÌ, ÿê³ íàâ÷à-
ëèñü ç ñàìîãî ïî÷àòêó ÔÐÌ, ë³êàð³ òàêîæ çàëó÷à-
ëèñü, ÿê ç á³îëîã³÷íèõ îáëàñòåé (òàêèõ ÿê àíàòî-
ì³ÿ ³ ô³ç³îëîã³ÿ), òàê ³ ç âèçíàíèõ êë³í³÷íèõ ñôåð
(òàêèõ ÿê íåâðîëîã³ÿ, îðòîïåä³ÿ, ñïîðòèâíà ìåäè-
öèíà òà ðåâìàòîëîã³ÿ). Òàêîæ áóâ âïëèâ ç áîêó
íåë³êàð³â, îñîáëèâî ïñèõîëîã³â, à òàêîæ ç áîêó
³íøèõ ïîâåä³íêîâèõ íàóê ³ òåõí³÷íèõ îáëàñòåé. Íàó-
êîâà ä³ÿëüí³ñòü ïîâèííà áóòè ò³ñíî ïîâ’ÿçàíîþ ç
êë³í³÷íèì ðîçâèòêîì ñïåö³àëüíîñò³, ³ öå òàêîæ ñòî-
ñóºòüñÿ ÔÐÌ. Ïðîòÿãîì íàóêîâîãî ðîçâèòêó äî-
ñèòü ðàíî ç’ÿâèëèñÿ äîñë³äæåííÿ, ïîâ’ÿçàí³ â îñíîâ-
íîìó ç á³îìåäèöèíîþ òà òåõíîëîã³ÿìè (ïåðåâàæíî
ìåõàí³÷íà òà åëåêòðîííà á³î³íæåíåð³ÿ), òà ç êë³í³÷íè-
ìè ñïîñòåðåæíèìè äîñë³äæåííÿìè, à ïîò³ì çá³ëüøè-
ëàñü ê³ëüê³ñòü ðàíäîì³çîâàíèõ êîíòðîëüîâàíèõ äîñ-
ë³äæåíü (ÐÊÄ) òà ìåòîäîëîã³÷íèõ äîñë³äæåíü,
îñîáëèâî, ç âèì³ðþâàííÿì ðåçóëüòàò³â.
Âàæëèâ³ñòü «çîâí³øíüîãî» âïëèâó
³ ðîçâèòîê îáëàñòåé äîñë³äæåííÿ
Íà äîñë³äæåííÿ â îáëàñò³ ÔÐÌ âïëèâàëè
çîâí³øí³ ôàêòîðè (òàê³ ÿê ̳æíàðîäíà êëàñèô³êà-
75
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ö³ÿ ïîðóøåíü, îáìåæåíü æèòòºä³ÿëüíîñò³ òà ñîö-
³àëüíî¿ íåäîñòàòíîñò³ ÌÊÏ, ³ ̳æíàðîäíà êëàñè-
ô³êàö³ÿ ôóíêö³îíóâàííÿ, îáìåæåíü æèòòºä³ÿëüíîñò³
òà çäîðîâ’ÿ, ÌÊÔ), íîâ³ çíàííÿ ç ñó÷àñíèõ ïñèõî-
ìåòðè÷íèõ òåõí³ê, á³îìåäè÷íî¿ ãàëóç³ (íàïð. ç íåé-
ðîïëàñòè÷íîñò³ òà äîñë³äæåííÿ ñòîâáóðîâèõ
êë³òèí), à òàêîæ ðîçâèòîê íîâèõ òåõíîëîã³é. ÌÊÏ,
îïóáë³êîâàíà Âñåñâ³òíüîþ îðãàí³çàö³ºþ îõîðîíè
çäîðîâ’ÿ (ÂÎÎÇ) â 1980 ðîö³, í³êîëè øèðîêî íå
âèêîðèñòîâóâàëàñü, ïðîòå íàäàëà êîíöåïòóàëüíèé
³ìïóëüñ ðîçâèòêó ÔÐÌ, à òàêîæ ìàëà âïëèâ íà
ðîçðîáêó ìåòîä³â âèì³ðþâàííÿ ðåçóëüòàò³â. Âîíà
çàçíàëà êðèòèêè ç ð³çíèõ ïðè÷èí, íàïðèêëàä, ÷åðåç
çàíàäòî ò³ñíèé çâ’ÿçîê ç òðàäèö³éíîþ á³îìåäè÷íî¿
ìîäåëëþ, à òàêîæ çà ¿¿ òåðì³íîëîã³þ. Êîëè â 2001
ðîö³ âîíà áóëà äàë³ ïåðåòâîðåíà â ÌÊÔ, á³ëüø
çíà÷íèé âïëèâ áóëî â³äçíà÷åíî âæå íà ðàíí³é ñòà䳿.
Âîíà òàêîæ ìàëà á³ëüø â³äïîâ³äíó òåðì³íîëîã³þ,
ÿêà ìîãëà áóòè âèðàæåíîþ íå ò³ëüêè â íåãàòèâíî-
ìó, íî ³ â ïîçèòèâíîìó âèì³ðàõ. Çàâäÿêè ö³é êëà-
ñèô³êàö³¿, çá³ëüøèâñÿ ³íòåðåñ äî äîñë³äæåíü â îá-
ëàñò³ ÔÐÌ, à òàêîæ ìîæëèâ³ñòü ïðîñóâàííÿ äî
á³î-ïñèõî-ñîö³àëüíî¿ ìîäåë³ îáìåæåííÿ æèòòºä³-
ÿëüíîñò³. Íåîáõ³äíî áóëî ðîçðîáèòè ³ çàñòîñóâà-
òè ìåòîäîëîã³þ, ÿêà ï³äõîäèòü äëÿ äîñë³äæåíü â
îáëàñòÿõ àêòèâíîñò³ òà ó÷àñò³, ùî â çíà÷í³é ì³ð³
îçíà÷ຠâèêîðèñòàííÿ ³íñòðóìåíò³â ç êàòåãîð³àëü-
íèì äàíèìè (ïîðÿäêîâ³ øêàëè), ùî âèìàãàþòü
ñó÷àñíî¿ ïñèõîìåòðè÷íî¿ ìåòîäîëî㳿. Âåëèêîþ
äîïîìîãîþ ó öüîìó ðîçâèòêó ñòàëî ââåäåííÿ àíà-
ë³çó Ðàø ó äîñë³äæåííÿõ ç ÔÐÌ. Ñïî÷àòêó äàòñü-
êèé ìàòåìàòèê Ãåîðã Ðàø ðîçðîáèâ ìåòîäîëîã³þ
Ðàø. Âîíà áàçóºòüñÿ íà ñï³ââ³äíîøåíí³ çäàòíîñò³
ñóá’ºêò³â òà ñêëàäíîñò³ ïðåäìåò³â, ç â³äîáðàæåí-
íÿì ðåçóëüòàò³â â ëîã³ò-îäèíèöÿõ. ßêùî äàí³ â³äïî-
â³äàþòü ìîäåë³, ïåðâèíí³ äàí³ ìîæóòü áóòè ïåðå-
òâîðåí³ â îö³íêè ³íòåðâàëüíèõ ð³âí³â, ùî º
êëþ÷îâîþ âèìîãîþ äëÿ âèì³ðþâàííÿ çì³í. Ðàíí³
³í³ö³àòèâè ç âèêîðèñòàííÿ ìåòîäîëî㳿 Ðàø â ÔÐÌ
áóëè çðîáëåí³ â 90-õ ðîêàõ â ÑØÀ, ³ íàäàë³ ³íòåðåñ
ïîøèðèâñÿ äî ªâðîïè. Ó òîé æå ÷àñ, òà îñîáëèâî
ïðîòÿãîì îñòàíí³õ 20 ðîê³â, çðîñëè ðîçóì³ííÿ òà
ïðàêòè÷íà ìîæëèâ³ñòü âèêîðèñòàííÿ ðàíäîì³çîâà-
íèõ êîíòðîëüîâàíèõ äîñë³äæåíü (ÐÊÄ). Ó ÔÐÌ òàê³
äîñë³äæåííÿ âàæëèâ³ äëÿ îá’ºêòèâíî¿ îö³íêè ïðîãðàì
âòðó÷àííÿ, àëå ìîæóòü ìàòè ïåâí³ ïðàêòè÷í³ îáìå-
æåííÿ. Êð³ì òîãî, áóëà ðîçðîáëåíà òåõíîëîã³ÿ, ùî
ñòîñóºòüñÿ äîñë³äæåíü â ÔÐÌ, íàïðèêëàä â îðòå-
çóâàíí³ òà ðîáîòîòåõí³ö³, â òåõíîëîã³ÿõ àíàë³çó ðóõó
òà â íåéðîô³ç³îëî㳿, à òàêîæ ïðè ô³çè÷í³é àêòèâíîñò³
â ðåàëüíîìó æèòò³ (íàïð. ÷åðåç äàò÷èêè, ùî ìîæ-
ëèâî íîñèòè). Âñ³ ö³ ðîçðîáêè ðîçøèðèëè ìîæëèâîñò³
äëÿ êë³í³÷íèõ äîñë³äæåíü ó ÔÐÌ.
Çðîñòàþ÷à ê³ëüê³ñòü íåìåäè÷íèõ ðåàá³ë³òàö³é-
íèõ ïðîôåñ³é, òàêèõ ÿê åðãîòåðàïåâòè, ô³çè÷í³ òå-
76 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ðàïåâòè òà íåéðîïñèõîëîãè, ÿê³ ïðîâîäÿòü äîñë³ä-
æåííÿ â ãàëóç³ ÔÐÌ, ðîçøèðèëà êîìïåòåíòíîñò³
ìóëüòè-ïðîôåñ³éíî¿ êîìàíäè ÔÐÌ. Ðîçðîáëåíî
â³äïîâ³äí³ ìîäåë³ íå ò³ëüêè äëÿ ìóëüòè-ïðîôåñ³é-
íèõ äîñë³äæåíü, àëå é äëÿ òðàíñëÿö³éíèõ äîñë³ä-
æåíü, âèêîðèñòîâóþ÷è ïåðåâàãè ñï³âïðàö³ ì³æ ôóí-
äàìåíòàëüíèìè ³ êë³í³÷íèìè äîñë³äæåííÿìè.
Íàóêîâ³ çóñòð³÷³ ³ êîíãðåñè ºâðîïåéñüêèõ
îðãàí³çàö³é ÔÐÌ. Ñòâîðåííÿ Êîêðàí³âñüêî¿
ñôåðè ÔÐÌ
Çóñòð³÷³ òà êîíãðåñè, îðãàí³çîâàí³ ð³çíèìè íàó-
êîâèìè îðãàí³çàö³ÿìè, çðîáèëè âíåñîê äî êîìóí³-
êàö³¿ ³ ðîçâèòêó íàóêè â ÔÐÌ, îñîáëèâî ïðîòÿãîì
îñòàíí³õ äâàäöÿòè ðîê³â, êîëè íàóêîâà ÿê³ñòü òà-
êèõ çóñòð³÷åé çðîñëà. Òàêîæ áóëî îðãàí³çîâàíî ðÿä
ñèìïîç³óì³â, êóðñ³â òà ì³æíàðîäíèõ øê³ë ç ÔÐÌ çà
ñïåö³àëüíèìè òåìàìè, òàêèìè, ÿê àíàë³ç á³îìåõàí³-
êè òà ðóõ³â, íåéðîô³ç³îëîã³÷í³ îñíîâè ðåàá³ë³òàö³¿,
ìåòîäè÷í³ àñïåêòè âèì³ðþâàííÿ ðåçóëüòàò³â òîùî.
Íà ê³ëüêîõ êîíãðåñàõ áóëè âêëþ÷åí³ ³íôîðìàö³éí³
òà îñâ³òí³ ñåñ³¿ ç íàóêîâèõ ïóáë³êàö³é, â òîìó ÷èñë³
«Çóñòð³÷ ç ðåäàêòîðîì» ³ «ßê íàïèñàòè íàóêîâó
ðîáîòó». ̳æíàðîäí³ îðãàí³çàö³¿ «International Re-
habilitation Medicine Association» òà «International
Federation of Physical and Rehabilitation Medicine»
îá’ºäíàëèñü ó 1999 ó «International Society of Physi-
cal and Rehabilitation Medicine» (ISPRM), ÿêà º âñå-
ñâ³òíüîþ îðãàí³çàö³ºþ ç ÔÐÌ ç àêòèâíîþ ó÷àñòþ
ºâðîïåéñüêèõ â÷åíèõ. Ç ºâðîïåéñüêî¿ ïåðñïåêòèâè,
â 1963 ðîö³ áóëà çàñíîâàíà «European Federation of
Physical Medicine and Rehabilitation», ³ ñåðåä ¿¿ ö³ëåé
áóëî ïðîñóâàííÿ íàö³îíàëüíèõ òîâàðèñòâ ÔÐÌ òà
ïîâ’ÿçàíèõ ç íèìè êîíãðåñ³â. Ôåäåðàö³ÿ çì³íèëà
ñâîº ³ì’ÿ â 2003 ðîö³ íà «ªâðîïåéñüêå òîâàðèñòâî
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè» (ªÒÔÐÌ),
ÿê öå âæå áóëî ñêàçàíî, çáåð³ãàþ÷è ñâîþ ìåòó
áóòè ïðîâ³äíèì íàóêîâèì òîâàðèñòâîì äëÿ ºâðî-
ïåéñüêèõ ë³êàð³â ÔÐÌ, âêëþ÷àþ÷è ºâðîïåéñüêèé
ùîäâîð³÷íèé íàóêîâèé êîíãðåñ. Êð³ì òîãî, â ªâðîï³
ïðàöþþòü ùå äâà ðåã³îíàëüí³ îðãàí³çàö³¿ ç ÔÐÌ:
«Mediterranean Forum of Physical and Rehabilitation
Medicine» (MFPRM) ç éîãî ïåðøèì êîíãðåñîì ó
1996 ðîö³ òà «Baltic and North Sea Forum on Physical
and Medical Rehabilitation» (BNFPRM) ç ïåðøèì
êîíãðåñîì ó 2010 ðîö³. Îáèäâ³ ö³ îðãàí³çàö³¿ òàêîæ
çàëó÷àþòü ó÷àñíèê³â ç â³äïîâ³äíèõ ðåã³îí³â ªâðî-
ïè ³ îðãàí³çîâóþòü ùîäâîð³÷íèé êîíãðåñ ç ÔÐÌ â
ñâîºìó ðåã³îí³.
Êîêðàí³âñüêà ðåàá³ë³òàö³éíà ñôåðà
Çà ³í³ö³àòèâè ñïåö³àëüíîãî íàóêîâîãî êîì³òåòó
ç äîêàçîâî¿ ìåäèöèíè ªâðîïåéñüêîãî òîâàðèñòâà
ô³çè÷íî¿ ³ ðåàá³ë³òàö³éíî¿ ìåäèöèíè òà ñõâàëåííÿ
³íøèõ ªâðîïåéñüêèõ Îðãàí³â ÔÐÌ áóëî ñòâîðåíî
¹2(2) *2018

Êîêðàí³âñüêó ðåàá³ë³òàö³éíó ñôåðó, ÿêó áóëî çàïó-
ùåíî 16 ãðóäíÿ 2016 ðîêó. Çàâäÿêè öüîìó, à òàêîæ
ñï³âðîá³òíèöòâó ó ö³é íîâ³é ãàëóç³ âåëèêî¿ ê³ëüêîñò³
ë³êàð³â ÔÐÌ òà ³íøèõ ôàõ³âö³â ðåàá³ë³òàö³¿, â ìàé-
áóòíüîìó áóäå ìîæëèâîþ ñóòòºâî ïîñèëèòè íàó-
êîâ³ äîêàçè â íàø³é ñïåö³àëüíîñò³, äîçâîëÿþ÷è
ñåðåä ³íøîãî âäîñêîíàëèòè ìåòîäîëîã³þ äîñë³ä-
æåííÿ â ðåàá³ë³òàö³¿, ñòâîðèòè íîâ³ íàñòàíîâè ç
êë³í³÷íî¿ ïðàêòèêè, à òàêîæ ³íø³ ïåðåâàãè äëÿ ðåà-
á³ë³òàö³¿26. (www.rehabilitation.cochrane.org).
Ðîçâèòîê íàóêîâèõ æóðíàë³â ó ªâðîï³
Íàóêîâ³ æóðíàëè º îäíèìè ç íàéâàæëèâ³øèõ
ôàêòîð³â, ùî ñïðèÿþòü çðîñòàííþ íàóêè ó ñïå-
ö³àëüíîñò³ ÔÐÌ.  ªâðîï³ º âåëèêà ê³ëüê³ñòü íà-
ö³îíàëüíèõ æóðíàë³â ç ÔÐÌ, à òàêîæ æóðíàë³â, ùî
ïîøèðþþòüñÿ íà ì³æíàðîäíîìó ð³âí³. Ôàêòè÷íî â
ïàïåðîâ³é ôîðì³ ïðåäñòàâëåí³ äåñÿòü íàö³îíàëüíèõ
æóðíàë³â ç Áîëãàð³¿, Õîðâàò³¿, Ôðàíö³¿, ͳìå÷÷èíè
òà Àâñòð³¿, Ïîðòóãà볿, Ñëîâåí³¿, ²ñïàí³¿, Òóðå÷÷è-
íè, ÿê³ íàëåæàòü äî ªâðîïåéñüêî¿ ìåðåæ³ æóðíàë³â
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè (http://
www.esprm.net/journal-network)27, àëå öå ïîëå ïî-
ñò³éíî åâîëþö³îíóº. Òðè ãîëîâíèõ æóðíàëè, áàçî-
âàíèõ â ªâðîï³, ùî ìàþòü ôàêòè÷íèé çâ’ÿçîê ç
íàóêîâèìè òîâàðèñòâàìè ÔÐÌ òà ì³æíàðîäíó ïåðñ-
ïåêòèâó28 (â àëôàâ³òíîìó ïîðÿäêó): Clinical Rehabi-
litation, European Journal of Physical and Rehabili-
tation Medicine òà Journal of Rehabilitation Medicine.
ªâðîïåéñüê³-ì³æíàðîäí³ æóðíàëè ç ÔÐÌ
Äëÿ òîãî, ùîá äàòè äåÿê³ íàãîëîñè ùîäî çì³í â
íàóêîâ³é àêòèâíîñò³ â ñôåð³ ÔÐÌ ªâðîïè, ìè ñïå-
ö³àëüíî ðîçãëÿíóëè çì³ñò òðüîõ âèùåâêàçàíèõ æóð-
íàë³â ÔÐÌ ó òðüîõ ÷àñîâèõ òî÷êàõ – 1975, 1995 òà
2015 ðîêè (ùîäî Clinical Rehabilitation ëèøå îñòàíí³
äâ³ òî÷êè) ñòîñîâíî òåìàòèêè ñòàòåé çà îñòàíí³ 40
ðîê³â.
Clinical Rehabilitation (Cr) 1987
Öå îô³ö³éíèé æóðíàë British Society of
Rehabilitation Medicine, ñï³ëüíî ç Society for Re-
search in Rehabilitation. Ó 1997 ðîö³ â³í ïðèºäíàâñÿ
äî Journal of Rehabilitation Sciences ³ ñòàâ îô³ö³é-
íèì æóðíàëîì Netherlands Society of Rehabilitation
and Physical Medicine. Çàâæäè ïóáë³êóºòüñÿ àíã-
ë³éñüêîþ ìîâîþ, ³íäåêñóºòüñÿ Medline ç 1995 ðîêó
òà ìຠ³ìïàêò-ôàêòîð ç 1995 ðîêó. Æóðíàë ïî÷àâ
âèäàâàòèñÿ â 1987 ðîö³. ×èñëî îö³íî÷íèõ äîñë³ä-
æåíü ïîñòóïîâî ï³äâèùóâàëîñÿ, îñîáëèâî ÐÊÄ
âèðîñëè ó ï’ÿòü-ñ³ì ðàç³â â ïåð³îä ç 1987-1995 ðð. äî
2002 ð.29. Ó 1995 ðîö³ æóðíàë ð³øó÷å âèñòóïàâ çà
çá³ëüøåííÿ ÐÊÄ â ðåàá³ë³òàö³éíèõ äîñë³äæåííÿõ30.
ijéñíî, ïðîòÿãîì ðîê³â öå áóëî óñï³øíî çðîáëåíî,
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 4 – ²ÑÒÎÐ²ß ÑÏÅÖ²ÀËÜÍÎÑÒ²: DzÄÊÈ ÏÎÕÎÄÈÒÜ ÔÐÌ
³ç çá³ëüøåííÿì â³äñîòêó îïóáë³êîâàíèõ ÐÊÄ ç 18%
ó 1995 ðîö³ äî 50% ó 2015 ðîö³. Ó òîé æå ÷àñ ñïî-
ñòåðåæí³ äîñë³äæåííÿ, âêëþ÷àþ÷è ÿê³ñí³ äîñë³ä-
æåííÿ, çíèçèëèñü ç 48% äî 2%. Ìåòîäîëîã³÷í³
ñòàòò³ çíèçèëèñü ç 20% ó 1995 ðîö³ äî 12% ó 2015
ðîö³, ³, íà æàëü, áóëî îïóáë³êîâàíî äóæå ìàëî äîñ-
ë³äæåíü ç âèêîðèñòàííÿì àíàë³çó Ðàø. Îãëÿäè áóëè
â³äñóòí³ìè â 1995 ðîö³, àëå ñòàíîâèëè 24% ñòàòåé
ó 2015 ðîö³. Òåìè äëÿ ñòàòåé áóëè äîñèòü ïîñò³éíè-
ìè, ³ íåâðîëîã³÷í³ ñòàíè ñòàíîâèëè áëèçüêî ïîëî-
âèíè ñòàòåé ç äåÿêèì çá³ëüøåííÿì ì³æ äâîìà
÷àñîâèìè ïîçíà÷êàìè. Îñîáëèâèé ³íòåðåñ áóâ ðîç-
âèíóòèé äî âñòàíîâëåííÿ ö³ëåé òà îïèñó âòðó÷àíü.
 äàíèé ÷àñ æóðíàë íàìàãàºòüñÿ çá³ëüøèòè òàêîæ
äóæå âàæëèâó ³ äóæå ñëàáîðîçâèíåíó òåîðåòè÷íó
áàçó äëÿ ðåàá³ë³òàö³¿.
European Journal of Physical and
Rehabilitation Medicine (EJPRM) (1964),
êîëèøí³é “Europa Medicophysica” –
îô³ö³éíèé æóðíàë ªÒÔÐÌ òà Ñåêö³¿
òà Ðàäè ÔÐÌ ªÑÌÑ
Æóðíàë ïî÷àâ ïóáë³êóâàòèñü ó 1965 ðîö³ ÿê
Europa Medicophysica. Ç ñàìîãî ïî÷àòêó öå áóâ
îô³ö³éíèé æóðíàë European Federation of Physical
Medicine and Rehabilitation, ï³çí³øå ñòàâ ªÒÔÐÌ,
ç 19 êðà¿íàìè, ïðåäñòàâëåíèìè â ðåäàêö³éí³é ðàä³.
³í ïóáë³êóºòüñÿ ñï³ëüíî ç International Society of
PRM (ISPRM) ³ º îô³ö³éíèì æóðíàëîì
Mediterranean Forum of Physical and Rehabilitation
Medicine (MFPRM). Ïóáë³êóâàâñÿ òðüîìà ìîâà-
ìè (³òàë³éñüêà, ôðàíöóçüêà òà àíãë³éñüêà) äî 1994
ðîêó, êîëè àíãë³éñüêèé ñòàâ ºäèíîþ ìîâîþ. ²íäåê-
ñîâàíèé Medline ç 2004 ðîêó ³ ìຠ³ìïàêò-ôàêòîð ç
2010 ðîêó. ²ì’ÿ æóðíàëó çì³íèëîñÿ íà ïîòî÷íå â
2008 ðîö³. Ñïî÷àòêó äîì³íóâàëè ñòàòò³ ç ϳâäåí-
íî¿ ªâðîïè, àëå â 2007 ðîö³ ñòàâ ì³æíàðîäíî îð³º-
íòîâàíèì. ʳëüêà ÐÊÄ áóëè îïóáë³êîâàí³ â 1975 òà
1995 ðð., àëå â 2015 ðîö³ ¿õ ê³ëüê³ñòü ïîì³òíî çðîñ-
ëà (23% ïóáë³êàö³é). ³äñîòîê ñïîñòåðåæíèõ äîñ-
ë³äæåíü áóâ äîñèòü âèñîêèì: 19% (1975), 29%
(1995) òà 41% (2015) â³äïîâ³äíî. Ìåòîäîëîã³÷í³
äîñë³äæåííÿ ïî÷àëè ç’ÿâëÿòèñÿ â 1995 ðîö³, âêëþ-
÷àþ÷è ³íîä³ ñòàòò³ ç âèêîðèñòàííÿì àíàë³çó Ðàø.
Ó 1975 ðîö³ ÷àñòî çóñòð³÷àëèñÿ îãëÿäîâ³ ñòàòò³ òà
ñïåö³àëüí³ äîïîâ³ä³ (56%), òîä³ ÿê â á³ëüø ï³çí³ ðîêè
âîíè íå áóëè òàêèìè äîì³íóþ÷èìè. Ïóáë³êàö³¿, ùî
ñòîñóþòüñÿ íåâðîëîã³÷íèõ ïîðóøåíü, ñòàíîâèëè
ïðèáëèçíî ïîëîâèíó, àáî òðîõè ìåíøå â³ä îïóáë³-
êîâàíèõ ïðàöü, ïðè öüîìó ç 1975 ïî 1995 ð³ê çíà÷-
íî çá³ëüøèëàñü ê³ëüê³ñòü ïóáë³êàö³é ç ì’ÿçîâî-ñêå-
ëåòíèõ ïîðóøåíü ³ áîëüîâèõ ñèíäðîì³â, ñêëàâøè
29% ó 2015 ðîö³. Îñíîâíèì íàïðÿìêîì ä³ÿëüíîñò³
æóðíàëó º ïóáë³êàö³¿ êë³í³÷íî çíà÷óùèõ ñòàòåé, ùî
ñïðèÿþòü ïîêðàùåííþ êë³í³÷íî¿ ïðàêòèêè ÔÐÌ31.
77
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Journal of Rehabilitation Medicine (JRM)
(1969), êîëèøí³é “Scandinavian Journal
of Rehabilitation Medicine” – îô³ö³éíèé
æóðíàë ISPRM, Ðàäè ÔÐÌ ªÑÌÑ òà ªÀÐÌ
Ïî÷àâ ïóáë³êóâàòèñü ó 1968 ðîö³ ÿê Scandinavian
Journal of Rehabilitation Medicine, ³ çì³íèâ ñâîþ
íàçâó â 2001 ðîö³. Ñïî÷àòêó ïóáë³êàö³¿ áóëè ìàé-
æå âèêëþ÷íî ç êðà¿í ϳâí³÷íî¿ ªâðîïè, àëå äîñèòü
ñêîðî ÷àñòêà ðóêîïèñ³â ç ³íøèõ ÷àñòèí ñâ³òó
çá³ëüøèëàñÿ (áëèçüêî 50% â 1996 ðîö³ ³ 80% â 2015
ðîö³), ñïî÷àòêó ÷åðåç çá³ëüøåííÿ ºâðîïåéñüêèõ
ìàòåð³àë³â, à ï³ñëÿ 2005 ðîêó òàêîæ çà ðàõóíîê
íåºâðîïåéñüêèõ ðóêîïèñ³â. ÐÊÄ íå ïóáë³êóâàëèñü
â 1975 ðîö³, àëå ç’ÿâèëèñÿ â 1995 ðîö³ ³ ñêëàäàëè
21%, à â 2015 ðîö³ – 27%; íàâïàêè, íåêîíòðîëüî-
âàí³ îö³íî÷í³ äîñë³äæåííÿ çíèçèëèñü (ç 25% ó 1975
äî 8% ó 2015). ²ñíóâàâ ³íòåðåñ äî ïóáë³êàö³¿ ð³çíèõ
òèï³â ìåòîäîëîã³÷íèõ äîñë³äæåíü, ùî ñòàíîâèëè
áëèçüêî ÷âåðò³ îïóáë³êîâàíèõ ñòàòåé ïðîòÿãîì
ïåð³îäó. ×èñëî ñòàòåé, ùî âèêîðèñòîâóþòü àíàë³ç
Ðàø, çá³ëüøèëîñü, àëå ¿õ áóëî âñå ùå â³äíîñíî
ìàëî ïîð³âíÿëüíî ç ê³ëüê³ñòþ ñòàòåé, ùî âèêîðèñ-
òîâóþòü ïîðÿäêîâó øêàëó. Îãëÿäè òà ñïåö³àëüí³
çâ³òè ïî÷àëè ç’ÿâëÿòèñÿ ïðèáëèçíî ç 2000 ðîêó, ³ â
2015 ðîö³ âîíè ñêëàäàëè 11% â³ä îïóáë³êîâàíèõ
ñòàòåé. Òåìè ñòàòåé áóëè äîñèòü ïîñò³éíèìè ç
2004 ïî 2011 ð³ê ³ çà âåñü ïåð³îä áëèçüêî 50% ñòà-
íîâèëè ñòàòò³ ç íåâðîëîã³÷íèõ ïîðóøåíü, áëèçüêî
25% ñòàòåé – ç ì’ÿçîâî-ñêåëåòíèõ ïîðóøåíü ³ áî-
ëüîâîìó ñèíäðîìó, à ðåøòà ñòàòåé – àáî ³íø³ ñòà-
íè, ÿê ñåðöåâ³ ³ ðåñï³ðàòîðí³ ñòàíè, àáî äàí³ äîñ-
ë³äæåíü çà ó÷àñòþ ê³ëüêîõ ãðóï ïàö³ºíò³â àáî
çäîðîâèõ ëþäåé, âêëþ÷àþ÷è ïîõèëèé â³ê.
²íø³ ºâðîïåéñüê³ íàóêîâ³ æóðíàëè ç ÔÐÌ
ç ì³æíàðîäíîþ ïðîåêö³ºþ
Òóò ìè ïðåäñòàâèìî êîðîòê³ ³ñòîðè÷í³ íîòàòêè
ïðî ³íø³ áàãàòîíàö³îíàëüí³ æóðíàëè, â ïîðÿäêó
ðîê³â ¿õ çàñíóâàííÿ.
Annals of Physical and Rehabilitation Medicine
(APRM) (1974), ðàí³øå «Annales
de R adaptation et de M decine Physique» –
îô³ö³éíèé æóðíàë ªÒÔÐÌ ³ Ñåêö³¿ ÔÐÌ
ªÑÌÑ
Îô³ö³éíèé æóðíàë French Society of Physical and
Rehabilitation Medicine (SOFMER, Soci t Franeaise
de M decine Physique and de R adaptation). Ïóáë³-
êóºòüñÿ ñï³ëüíî ç International Society of Physical
and Rehabilitation Medicine (ISPRM) ç 2012 ðîêó.
Âèäàâåöü – Elsevier, ÿêèé ïîøèðþº Annals ÷åðåç
Science Direct. Ïóáë³êóâàâñÿ âèêëþ÷íî ôðàíöóçü-
êîþ ìîâîþ äî 2005 ðîêó, ñòàâ äâîìîâíèì ç 2009
78 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ðîêó ³ ïóáë³êóºòüñÿ âèêëþ÷íî àíãë³éñüêîþ ìîâîþ
ç 2015 ðîêó. APRM ³íäåêñóºòüñÿ Medline ç 2001
ðîêó, ùå íå ìຠ³ìïàêò- ôàêòîðó, ³ çàðàç º íàóêî-
âèì æóðíàëîì, ÿêèé â³äïîâ³äຠì³æíàðîäíèì ñòàí-
äàðòàì ³ îõîïëþº âñ³ ñôåðè òà àñïåêòè ðåàá³ë³òà-
ö³éíèõ íàóê, â³ä ôóíäàìåíòàëüíèõ, äî ìåäè÷íèõ òà
ñîö³àëüíèõ. Æóðíàë ïóáë³êóº îðèã³íàëüí³ ðåöåíçî-
âàí³ êë³í³÷í³ òà äîñë³äíèöüê³ ñòàòò³, åï³äåì³îëîã³÷í³
äîñë³äæåííÿ, íîâ³ ìåòîäîëîã³÷í³ êë³í³÷í³ ï³äõîäè,
îãëÿäè, ðåäàêö³éí³ ñòàòò³ òà íàñòàíîâè. Ìàòåð³à-
ëè â îñíîâíîìó, ñòîñóþòüñÿ: ìåòîä³â îö³íþâàííÿ
ìîòîðíèõ, ñåíñîðíèõ, êîãí³òèâíèõ ³ â³ñöåðàëüíèõ
ïîðóøåíü; ôóíêö³îíàëüíèõ îáìåæåíü æèòòºä³ÿëü-
íîñò³; ô³çè÷íèõ âàä ó äîðîñëèõ ³ ä³òåé; ïðîöåñ³â
ðåàá³ë³òàö³¿ ïðè îðòîïåäè÷íèõ, ðåâìàòîëîã³÷íèõ,
íåâðîëîã³÷íèõ, ñåðöåâî-ñóäèííèõ, ëåãåíåâèõ òà
óðîëîã³÷íèõ çàõâîðþâàííÿõ.
Rehabilitación (Madr) (1966)
Îô³ö³éíèé æóðíàë Sociedad Española de
Rehabilitación y Medicina Fisica (SERMEF). Áóâ
çàñíîâàíèé â 1966 ðîö³ ðàäîþ äèðåêòîð³â Òîâàðè-
ñòâà. Âèäàâåöü – Elsevier-España, S.L.U., æóðíàë
âèïóñêàºòüñÿ ÷îòèðè ðàçè íà ð³ê ðàçîì ç ìîíîãðà-
ô³ºþ íà òåìó, ùî ïðåäñòàâëÿº íàéá³ëüøèé ³íòåðåñ
³ àêòóàëüí³ñòü, ÿêà ïðèçíà÷àºòüñÿ ðåäàêö³éíîþ
êîëå㳺þ. Âèäàºòüñÿ ³ñïàíñüêîþ ìîâîþ (êð³ì òåç,
ùî çàâæäè º ÿê ³ñïàíñüêîþ, òàê ³ àíãë³éñüêîþ ìî-
âàìè). Æóðíàë ùå íå ³íäåêñîâàíèé Medline, àëå
âêëþ÷åíèé â: IME, Eventline, Bibliomed, Sedbase,
CINAHL, Scopus, Pascal òà IBECS. ²ñòîð³ÿ æóðíà-
ëó ïîõîäèòü ç ïîïåðåäíüîãî æóðíàëó Acta
Fisioteràpica Ib rica (1956), ÿêèé áóâ îô³ö³éíèì æóð-
íàëîì “Sociedad Española de Fisioterapia
Reeducativa y Recuperaciîn Funcional”. Ó 1966 ðîö³
Acta Fisoteràpica Ib rica òà Revista Española de
Rehabilitación del Aparato Locomotor (äîïîâíåííÿ
äî æóðíàëó îðòîïåäè÷íî¿ õ³ðóð㳿) áóëè îá’ºäíàí³
â íîâèé æóðíàë. Rehabilitación (Madr) º îñíîâíèì
³íñòðóìåíòîì íàóêîâîãî ïîøèðåííÿ ñåðåä ë³êàð³â
ÔÐÌ â ²ñïàí³¿, à òàêîæ ç ³ñïàíîìîâíèõ êðà¿í Ëà-
òèíñüêî¿ Àìåðèêè. Îñíîâíîþ ñôåðîþ ä³ÿëüíîñò³
æóðíàëó º áåçïåðåðâíà ìåäè÷íà îñâ³òà â ñïåö³àëü-
íîñò³ ÔÐÌ.
International Journal of Rehabilitation Research
(IJRR) (1977)
Îô³ö³éíèé æóðíàë Rehabilitation International ç
1977 ïî 1985 ð³ê, à ïîò³ì, ç ìîìåíòó ñòâîðåííÿ,
European Federation of Research in Rehabilitation,
ÿêà ó 2009 ðîö³ áóëà ïåðåéìåíîâàíèé íà European
Forum for Research in Rehabilitation. Âèäàâö³:
Schindele (1977–1990), Chapman and Hall (1990–
1998), ³ çàðàç Lippincot Williams & Wilkins/Wolters
Kluwer (ç 1998). Çàâæäè âèäàâàâñÿ àíãë³éñüêîþ
¹2(2) *2018

ìîâîþ. ²íäåêñîâàíèé êîìïàí³ºþ Medline ç 1978
ðîêó òà ìຠ³ìïàêò-ôàêòîð ç 1997 ðîêó. Öå ìàé-
äàí÷èê äëÿ ïóáë³êàö³¿ äîñë³äæåíü ùîäî ôóíêö³îíó-
âàííÿ òà îáìåæåíü æèòòºä³ÿëüíîñò³ òà êîíòåêñòó-
àëüíèõ ôàêòîð³â, ÿê³ âïëèâàþòü íà æèòòºâèé äîñâ³ä
ëþäåé âñ³õ â³ê³â ÿê ó ðîçâèíåíèõ êðà¿íàõ, òàê ³ â
êðà¿íàõ, ùî ðîçâèâàþòüñÿ.  äàíèé ÷àñ â³í ìàº
³ìïàêò-ôàêòîð.
Physikalische Medizin – Rehabilitationsmedizin –
Kurortmedizin – Journal of Physical and
Rehabilitation Medicine (JPRM) (1991)
Öå îô³ö³éíèé æóðíàë ͳìåöüêîãî òîâàðèñòâà
ô³çè÷íî¿ ìåäèöèíè, Àâñòð³éñüêîãî òîâàðèñòâà
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè, ͳìåöüêî¿
ïðîôåñ³éíî¿ àñîö³àö³¿ ðåàá³ë³òàö³éíî¿ ìåäèöèíè òà
Àâñòð³éñüêî¿ ïðîôåñ³éíî¿ àñîö³àö³¿ ô³çè÷íî¿ òà ðå-
àá³ë³òàö³éíî¿ ìåäèöèíè. Âèäàºòüñÿ Georg Thieme.
Ó 2009 ðîö³ áóëî äîäàíî ï³äçàãîëîâîê æóðíàëó
Journal of Physical and Rehabilitation Medicine. 툼
³ìïàêò ôàêòîð ç 2015 ðîêó. Ïóáë³êóº ñòàòò³ íà
àíãë³éñüê³é òà í³ìåöüê³é ìîâàõ. Éîãî ³ñòîð³ÿ ñÿãàº
äî 1898 ðîêó, ç Zeitschrift fur diatetische und
physikalische Therapie (Journal of Dietary and
Physical Therapy), ùî ïðîäîâæèâñÿ â ͳìåöüê³é
Äåìîêðàòè÷í³é Ðåñïóáë³ö³ ç 1971 ðîêó ÿê Zeitschrift
for Physiotherapie; â Çàõ³äí³é ͳìå÷÷èí³, Zeitschrift
for Physikalische Medizin áóâ çàñíîâàíèé â 1970
ðîö³. Ó 1991 ðîö³ äâà òîâàðèñòâà ³ æóðíàëè Ñõ³äíî¿
³ Çàõ³äíî¿ Í³ìå÷÷èíè îá’ºäíàëèñÿ. Æóðíàë ñïåö³-
àë³çóºòüñÿ íà îðèã³íàëüíèõ ñòàòòÿõ, êë³í³÷íèõ âè-
ïàäêàõ òà íàâ÷àëüíèõ ñòàòòÿõ ç Ô³çè÷íî¿ ìåäèöè-
íè òà Ðåàá³ë³òàö³éíî¿ ìåäèöèíè, òåçàõ êîíãðåñ³â,
íîâèíàõ òîâàðèñòâ òà àñîö³àö³é.
Journal of the Portuguese Society of Physical
Medicine and Rehabilitation
Æóðíàë SPMFR âèäàºòüñÿ ç 1992 ðîêó, ³ º äî-
â³äíèêîì äëÿ âñ³õ ïîðòóãàëüñüêèõ ñïåö³àë³ñò³â
ÔÐÌ ³ äëÿ ìåäè÷íèõ òîâàðèñòâ Ïîðòóãà볿. Äðó-
êîâàí³ êîﳿ íàäñèëàþòüñÿ âñ³ì ÷ëåíàì SPMFR,
Sociedades Medicas de Portugal òà ð³çíèì ìåäè÷-
íèì á³áë³îòåêàì. ³í òàêîæ ïîøèðþºòüñÿ â ³íø³
ïîðòóãàëîìîâí³ êðà¿íè øëÿõîì ñï³âïðàö³ ç êîëåãà-
ìè ç Áðàçè볿, Àíãîëè, Ìîçàìá³êó, Êàáî-Âåðäå, Ãâ³-
íå¿-Á³ñàó, Ñàí-Òîìå ³ Ïðèíñ³ï³, Ñõ³äíîãî Òèìîðó.
Æóðíàë ïóáë³êóº îðèã³íàëüí³ ñòàòò³ òà îãëÿäè â
ãàëóç³ ðåàá³ë³òàö³éíî¿ ìåäèöèíè, ³ âñ³ ïðåäñòàâëåí³
ðóêîïèñè ïîâèíí³ â³äïîâ³äàòè âèìîãàì Committee
of Medical Journal Editors. SPMFR ìຠïîâíèé ïðî-
öåñ ðåöåíçóâàííÿ, ÷³òêî âèçíà÷åí³ ö³ë³ òà ñôåðó
çàñòîñóâàííÿ, òà âèçíà÷åííÿ êîíôë³êòó ³íòåðåñ³â
â³äïîâ³äíî äî Ðåêîìåíäàö³é ùîäî ïîâåä³íêè,
çâ³òíîñò³, ðåäàãóâàííÿ òà ïóáë³êàö³¿ íàóêîâî¿ ðîáî-
òè â ìåäè÷íèõ æóðíàëàõ (Ðåêîìåíäàö³¿ ICMJE).
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 4 – ²ÑÒÎÐ²ß ÑÏÅÖ²ÀËÜÍÎÑÒ²: DzÄÊÈ ÏÎÕÎÄÈÒÜ ÔÐÌ
Ñòàòò³ ìîæóòü áóòè ïîäàí³ àíãë³éñüêîþ, ôðàíöóçü-
êîþ òà/àáî ïîðòóãàëüñüêîþ ìîâàìè. Òåçè ïîâèíí³
áóòè àíãë³éñüêîþ òà ³íøîþ ìîâîþ (ôðàíöóçüêîþ
àáî ïîðòóãàëüñüêîþ).
Âèñíîâêè äëÿ æóðíàë³â ç ÔÐÌ
Íàóêîâ³ äîñë³äæåííÿ â ö³é ìåäè÷í³é ñïåö³àëü-
íîñò³ çðîñòàëè ïðîòÿãîì ìèíóëîãî ñòîë³òòÿ ³ ïðî-
äîâæóþòüñÿ â òåïåð³øí³é ÷àñ. Äîñë³äæåííÿ ãîëîâ-
íèì ÷èíîì ïîâ’ÿçàí³ ç á³îìåäèöèíîþ òà
òåõíîëîã³ÿìè (â îñíîâíîìó ìåõàí³÷íîþ òà åëåêò-
ðîííîþ á³î³íæåíåð³þ), à òàêîæ ç êë³í³÷íîþ ïðàê-
òèêîþ ³ç ñïîñòåðåæíèìè ïðîñïåêòèâíèìè äîñë³ä-
æåííÿìè, ùî ç’ÿâèëèñÿ íà ðàíí³õ ñòàä³ÿõ, à ï³çí³øå
çá³ëüøèëàñÿ ê³ëüê³ñòü ðàíäîì³çîâàíèõ êîíòðîëüî-
âàíèõ äîñë³äæåíü (ÐÊÄ) òà ìåòîäîëîã³÷íèõ äîñ-
ë³äæåíü, îñîáëèâî ç âèì³ðþâàííÿì ðåçóëüòàò³â.
ªâðîïåéñüê³ àâòîðè ç ÔÐÌ ïóáë³êóþòü âñå á³ëüøå
ñâî¿õ äîñë³äæåíü ó êë³í³÷í³é òà åêñïåðèìåíòàëüí³é
ñôåðàõ íå ò³ëüêè â æóðíàëàõ ç ÔÐÌ (äåÿê³ ç íèõ
³íäåêñóþòüñÿ Medline òà ìàþòü ³ìïàêò-ôàêòîð), à
òàêîæ â ³íøèõ ïðîâ³äíèõ æóðíàëàõ, ùî íàëåæàòü
äî ð³çíèõ á³îìåäè÷íèõ êàòåãîð³é. Ùî ñòîñóºòüñÿ
òèïó ñòàòåé, ùî ïóáë³êóþòüñÿ, çà îñòàíí³ 40 ðîê³â
çíà÷íî á³ëüøîãî ïîøèðåííÿ íàáóëè ñòàòò³ ç ðàí-
äîì³çîâàíèõ êîíòðîëüîâàíèõ äîñë³äæåíü (ÐÊÄ).
Âîäíî÷àñ, ê³ëüê³ñòü êë³í³÷íèõ äîñë³äæåíü, îïóáë³-
êîâàíèõ ó ìåäè÷íèõ æóðíàëàõ, ³íäåêñîâàíèõ
PubMed, âêëþ÷àþ÷è êëþ÷îâå ñëîâî «Physical
Medicine and Rehabilitation», çðîñëà ç 65 â 2006 ðîö³
äî 200 ó 2015 ðîö³. Äîäàòêîâî, â òåïåð³øí³é ÷àñ
ê³ëüê³ñòü êë³í³÷íèõ âèïðîáóâàíü, çàðåºñòðîâàíèõ
íà ClinicalTrial.gov òà ðîçòàøîâàíèõ ó ªâðîï³, ñòà-
íîâèòü áëèçüêî òðåòèíè ñâ³òîâîãî îáñÿãó ïðè ïî-
øóêó çà êëþ÷îâèì ñëîâîì «Rehabilitation
Medicine» (583/1764) àáî «Physical Medicine and
Rehabilitation»/«Physical and Rehabilitation
Medicine» (84/264). Âñå öå, ÿê ìè ñïîä³âàºìîñü,
ïîñèëèòü ìîæëèâîñò³ íàóêîâîãî âíåñêó äî êë³í³÷íî¿
ïðàêòèêè ÔÐÌ òà ªâðîïà çàéìຠâ öüîìó ïðîâ³äíó
ïîçèö³þ. Ó íàóêîâèõ ñòàòòÿõ çàçíà÷åíèõ æóðíàë³â
äîñë³äæóâàëèñÿ ãðóïè ïàö³ºíò³â ïåðåâàæíî ç íåâðî-
ëîã³÷íèìè ñòàíàìè, òà ïîò³ì – ì’ÿçîâî-ñêåëåòíè-
ìè òà áîëüîâèìè ñòàíàìè: öå â³ääçåðêàëþº
êë³í³÷íó ñèòóàö³þ â çàêëàäàõ ÔÐÌ. Äîäàòêîâî áóëè
ïðîâåäåí³ ìåòîäîëîã³÷í³ äîñë³äæåííÿ ÿê ç êîíñò-
ðóêö³¿, òàê ç ïñèõîìåòðè÷íèõ õàðàêòåðèñòèê ð³çíèõ
³íñòðóìåíò³â âèì³ðþâàííÿ ðåçóëüòàò³â. Íàðåøò³,
àëå íå ìåíø âàæëèâî – äîñë³äæåííÿ, ïîâ’ÿçàí³ ç
ÌÊÔ, âèêëèêàëè âåëèêèé ³íòåðåñ, ïî÷èíàþ÷è âæå
ç ïî÷àòêó íèí³øíüîãî ñòîë³òòÿ: áóëè îïóáë³êîâàí³
äåê³ëüêà ñòàòåé ùîäî êîíöåïòóàëüíèõ àñïåêò³â
ÌÊÔ òà ðîçâèòêó ¿¿ áàçîâèõ íàáîð³â, à òàêîæ ÌÊÔ,
ÿê îñíîâè äëÿ âèì³ðþâàííÿ ðåçóëüòàò³â ³ äëÿ
79
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ñòðóêòóðóâàííÿ äîñë³äæåíü òà êë³í³÷íî¿ ðîáîòè ó
ÔÐÌ. Íàóêîâ³ æóðíàëè º îäíèìè ç íàéâàæëèâ³øèõ
âêëàäíèê³â çðîñòàííÿ íàóêè ó ñïåö³àëüíîñò³ ÔÐÌ.
 ³ñòî𳿠¿õ ðîçâèòêó â ªâðîï³ º äåÿê³ ñï³ëüí³ ðèñè.
Âîíè, ÿê ïðàâèëî, íàðîäæóþòüñÿ íà ì³ñöåâîìó
ð³âí³, äëÿ ñëóãóâàííÿ êîíêðåòíîìó òîâàðèñòâó
ÔÐÌ ³ êðà¿í³, ³ åâîëþö³îíóþòü â ì³æíàðîäí³. Áàçè
äàíèõ (ïåðåâàæíî PubMed òà ISI ç éîãî ³ìïàêò-
ôàêòîðàìè), ùî íàðîäèëèñÿ â ÑØÀ ³ ñïî÷àòêó
âêëþ÷àëè, â îñíîâíîìó, àìåðèêàíñüê³ æóðíàëè,
ñòâîðèëè ïåðøèé ãîëîâíèé âèêëèê. Äðóãèì áóëà
òðàíñôîðìàö³ÿ íà àíãë³éñüêó ìîâó (äëÿ æóðíàë³â,
ùî áàçóþòüñÿ â íåàíãëîìîâíèõ êðà¿íàõ), ùî áóëî
îñîáëèâî âàæêî äëÿ ðåäàêòîð³â, àâòîð³â òà ÷èòà÷³â.
Íàðåøò³, ì³æíàðîäíà åâîëþö³ÿ ïðèìóñèëà íàé-
ñòàð³ø³ æóðíàëè çì³íèòè íàçâè, ùîá çðîáèòè ¿õ
á³ëüø ñó÷àñíèìè òà/àáî â³äïîâ³äàòè ä³éñíîìó
çì³ñòó.
Ïîñèëàííÿ
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2. Vl ek E. The Fossil Man of G novce Czechoslovakia. J. R.
Anthropol. Inst. 1955;163–7.
3. Conti A.A. Western medical rehabilitation through time: a
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4. Conti A.A. Reconstructing medical history: historiographical
features, approaches and challenges. Clin Ter. 2011;162:133–6.
5. Schmitt C., Mehlman C.T., Meiss A.L. Hyphenated history:
Erb-Duchenne brachial plexus palsy. Am J Orth 2008; 37 (7):
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6. Climent Barberá J.M. Formation of the concept of
rehabilitation in the gymnastic work of Sebasti n Busqu
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7. Peltier L.F. The “back school” of Delpech in Montpellier. Clin
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8. De Vierville J.P. Aquatic Rehabilitation: A Historical
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9. Pettman E. A history of manipulative therapy. J Man Manip
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10. Cyriax J. Textbook of orthopaedic medicine. Vol.2 Treatment
by Manipulation, Massage and Injection. London: Baillière
Tindall.1984.
11. Chaitow L. Palpation skills. Assessment and diagnostic
through touch. 3 rd edition. Harcourt Publisher Limited.
Churchill Livingstone 2000.
12. Meloche J. P., Bergeron Y., Bellavance A., Morand M., Hout J.,
Belzile G. Painful intervertebral disfunction: Robert Maigne´s
original contribution to headache of cervical origin. Headache.
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13. Janda V. Muscle fuction testing. London: Buttherworths; 1983.
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15. Lewit K. Disturbed balance due to lesions of the cranio-cervical
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16. Valero R., Varela E., Kåçåkdeveci A.A., Oral A., Ilieva E.,
Berteanu M., et al. Spinal pain management. The role of
physical and rehabilitation medicine physicians. The European
perspective based on the best evidence. A paper by the UEMS-
PRM Section Professional Practice Committee. Eur J Phys
Rehabil Med. 2013;49:715–25.
17. Draganski B., Gaser C., Busch V., Schuierer G., Bogdahn U.,
May A. Neuroplasticity: changes in grey matter induced by
training. Nature. 2004;427(6972):311–2.
18. Ogden J.A., Alvarez R.G., Levitt R., Marlow M. Shock wave
therapy (Orthotripsy) in musculoskeletal disorders. Clin
Orthop. Relat Res. 2001;387:22–40.
19. Del Castillo-Gonz lez F., Ramos-Alvarez J.J., Rodríguez-
Fabi n G., Gonz lez-P rez J., Jim nez-Herranz E., Varela E.
Extracorporeal shockwaves versus ultrasound-guided
percutaneous lavage for the treatment of rotator cuff calcific
tendinopathy: a randomized controlled trial. Eur. J. Phys.
Rehabil. Med. 2016;52:145–51.
20. Giustini A., Varela E., Franceschini M., Votava J., Zampolini M.,
Berteanu M., et al. UEMS—Position Paper. New technologies
designed to improve functioning: the role of the physical and
rehabilitation medicine physician. Eur. J. Phys. Rehabil. Med.
2014 ;50:579–83.
21. Reinhardt J.D., Zhang X., Prodinger B., Ehrmann-Bostan C.,
Selb M., Stucki G., et al. Towards the system-wide
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22. Bardot A., Tonazzi A. European physical and rehabilitation
medicine organisms—origins and developments. Eura
Medicophys. 2007;43:185–94.
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organizations of physical and rehabilitation medicine. Am J
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2009;52:594–607.
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on Physical and Rehabilitation Medicine in Europe. J Rehabil
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26. Negrini S., Kiekens C., Levack W., Grubisic F., Gimigliano
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517–20.
¹2(2) *2018
 ÐÎÇÄ²Ë 4 – ²ÑÒÎÐ²ß ÑÏÅÖ²ÀËÜÍÎÑÒ²: DzÄÊÈ ÏÎÕÎÄÈÒÜ ÔÐÌ

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Enrique Varela-
Donoso, Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph
Gutenbrunner, Carlotte Kiekens, Sasa Moslavac, Anthony B Ward, Mauro Zampolini, Stefano Negrini.
• Ó÷àñíèêè: Gunnar Grimby, Christoph Gutenbrunner, Xanthi Michail, Stefano Negrini, Philippe Bardot,
Nikolaos Barotsis, Carlo Bertolini, Kristian Borg, Joaquim Chaler, Anne Chamberlain, Nicolas Christodoulou,
Alain Delarque, Franco Franchignoni, Alessandro Giustini, Alvydas Juocevicius, Crt Marincek, Dominic
P rennou, Henk Stam, Ulrich Smolenski, Jiri Votava, Derrick T Wade, Juan M. Castellote, Maria Gabriella
Ceravolo, Gordana Deveñerski, Roser Garreta-Figuera, JC Miangolarra-Page, Merce Avellanet, Mauro
Zampolini, Maria Amparo Martinez-Assucena.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 81
 Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐM) â ªâðîï³
Ðîçä³ë 5 – Îðãàí³çàö³¿ ÔÐÌ â ªâðîï³: ñòðóêòóðà òà ä³ÿëüí³ñòü
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
Ó êîíòåêñò³ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ) â ªâðîï³ öåé äîêóìåíò ðîçãëÿäຠñòðóêòóðó,
îðãàí³çàö³þ òà ä³ÿëüí³ñòü îðãàí³çàö³é ÔÐÌ â ªâðîï³.
²ñíóº ÷îòèðè ãîëîâíèõ îðãàíè – Ñåêö³ÿ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè ªâðîïåéñüêîãî Ñîþçó ìåäè÷íèõ ñïåö³-
àë³ñò³â (ªÑÌÑ), ùî º äóæå áëèçüêîþ äî ªâðîïåéñüêîãî Ñîþçó, ³ ÿêà ïðàãíå âèçíà÷èòè ïðîôåñ³éí³ êîìïåòåíòíîñò³
ÔÐÌ, óïðàâë³ííÿ ÿê³ñòþ òà àêðåäèòàö³þ, à òàêîæ ðàçîì ç Ðàäîþ îñâ³òí³ ïèòàííÿ. ªâðîïåéñüêèé êîëåäæ ÔÐÌ – â îñîá³
Ðàäè ÔÐÌ ªÑÌÑ, òà éîãî îñíîâí³ íàïðÿìè ä³ÿëüíîñò³ àíàë³çóþòüñÿ íèæ÷å â ðîçä³ë³ îïèñó Ðàäè Ñåêö³¿ ÔÐÌ ªÑÌÑ.
ªâðîïåéñüêå òîâàðèñòâî ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ªÒÔÐÌ), ãîëîâíèì ÷èíîì, ïðèçíà÷åíå äëÿ ñïðèÿííÿ
ïðîâåäåííþ äîñë³äæåíü ó ñôåð³ ðåàá³ë³òàö³¿ òà ñòâîðåííÿ ìåðåæ³ çíàíü ç ÔÐÌ â ªâðîï³. ªâðîïåéñüêà àêàäåì³ÿ ðåàá³-
ë³òàö³éíî¿ ìåäèöèíè â îñíîâíîìó ïðèñâÿ÷åíà âèçíà÷åííþ åòè÷íèõ àñïåêò³â ðåàá³ë³òàö³¿ òà ïîøóêó ñòðàòåã³é äëÿ êðàùèõ
îñâ³òí³õ ï³äõîä³â ó ðåàá³ë³òàö³¿.
²ñíóº ùå 2 îðãàíè (ðåã³îíàëüí³ ôîðóìè), ìåòîþ ÿêèõ º ñòâîðåííÿ ìîñò³â ÷åðåç Ñåðåäçåìíîìîðñüêèé ðåã³îí (Mediterranean
Forum of PRM) òà ïî âñ³é ï³âí³÷í³é ªâðîï³, âêëþ÷àþ÷è ñõ³äí³ êðà¿íè, òàê³ ÿê Ðîñ³ÿ, Á³ëîðóñü òà Óêðà¿íà (Baltic and
North Sea Forum of PRM). Äëÿ ï³äòðèìêè çíàíü â ªâðîï³ ³ñíóþòü 7 îñíîâíèõ æóðíàë³â, ïðèñâÿ÷åíèõ ðåàá³ë³òàö³¿ ç³
çðîñòàþ÷èì ³ìïàêò-ôàêòîðîì.
Íàðåøò³, àëå íå ìåíø âàæëèâî, Îðãàíè ÔÐÌ ìàþòü âàæëèâó ðîëü ó âñüîìó ñâ³òîâ³, ùî ïîâ’ÿçàíî ç International Society
of PRM òà ÂÎÎÇ. Ñåêö³ÿ ªÑÌÑ çàòâåðäèëà ðóõ ì³æíàðîäíîãî ñï³âðîá³òíèöòâà.
Íà çàê³í÷åííÿ, ä³ÿëüí³ñòü ÔÐÌ ó ªâðîï³ íå îáìåæóºòüñÿ îô³ö³éíèì êîðäîíîì, àëå äî ìåðåæ³ âõîäÿòü ñõ³äí³ êðà¿íè òà
êðà¿íè Ñåðåäçåìíîìîð’ÿ. ªâðîïåéñüêà ðîçãàëóæåíà ìåðåæà ò³ñíî ïîâ’ÿçàíà ç ì³æíàðîäíèìè Îðãàíàìè ÔÐÌ, íàñàìïå-
ðåä International Society of PRM.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 5. The PRM organizations in Europe: structureand activities.
Eur J Phys Rehabil Med. 2018 Apr;54(2):198-213.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 5. Îðãàí³çàö³¿ ÔÐÌ â ªâðîï³: ñòðóêòóðà òà
ä³ÿëüí³ñòü. Óêðà¿íñüêèé æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 82-96.
Êëþ÷îâ³ ñëîâà: Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà, ªâðîïà, Íàóêîâ³ òîâàðèñòâà, Ïóáë³êàö³¿.

Ââåäåííÿ ÔÐÌ, ÷îìó ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì ëþäÿì

Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî
óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³î-
íàëüíîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòå-
ð³àë³â äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìó-
âàííÿ ïðî ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â
ðåàá³ë³òàö³¿ òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà
âàæëèâîñò³ ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ ñïåö³-
àëüí³ñòþ. Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïîíÿòòÿ
³ ñóñï³ëüñòâó, îñíîâè ÔÐÌ, ³ñòîð³ÿ ñïåö³àëüíîñò³
ÔÐÌ, ñòðóêòóðà ³ ä³ÿëüí³ñòü îðãàí³çàö³é ÔÐÌ â
ªâðîï³, çíàííÿ ³ íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà
êë³í³÷íèõ êîìïåòåíòíîñòåé ÔÐÌ, ì³ñöå ñïåö³àëü-
íîñò³ ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ ³
ñóñï³ëüñòâ³, îñâ³òà òà áåçïåðåðâíèé ïðîôåñ³éíèé
ðîçâèòîê ë³êàð³â ÔÐÌ, îñîáëèâîñò³ òà ïðîáëåìè
íàóêè òà äîñë³äæåíü â ÔÐÌ òà ïðîáëåìè òà ïåðñ-
ïåêòèâè ìàéáóòíüîãî ÔÐÌ.
Âïðîäîâæ áàãàòüîõ ðîê³â îðãàí³çàö³ÿ ñïåö³àëü-
íîñò³ Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà ðîçâè-
âàëàñü, ç îäíîãî áîêó, ç ìåòîþ ïîêðàùåííÿ ïðàê-
òè÷íî¿ ä³ÿëüíîñò³, à ç ³íøîãî - ç ìåòîþ ¿¿ óí³ô³êàö³¿
â ð³çíèõ êðà¿íàõ ªâðîïè. Ó öüîìó ðîçä³ë³ ïðåäñòàâ-

82 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
ëåí³ çàõîäè òà ïðîãðàìè óñ³õ â³äïîâ³äíèõ ºâðî-
ïåéñüêèõ îðãàí³çàö³é. Äî íèõ â³äíîñÿòüñÿ:
– ªâðîïåéñüê³ Îðãàíè ÔÐÌ, ÿê³ îá’ºäíàëèñÿ äëÿ
öüîãî òðåòüîãî âèäàííÿ Á³ëî¿ êíèãè, ñôîðìóâàâ-
øè Àëüÿíñ ªâðîïåéñüêèõ Îðãàí³â ÔÐÌ: âîíè
âêëþ÷àþòü ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òà-
ö³éíî¿ Ìåäèöèíè, ªâðîïåéñüêå òîâàðèñòâî
ÔÐÌ, Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó ìå-
äè÷íèõ ñïåö³àë³ñò³â (ªÑÌÑ) òà ªâðîïåéñüêèé
êîëåäæ ÔÐÌ (â îñîá³ Ðàäè ÔÐÌ ªÑÌÑ).
– Ðåã³îíàëüí³ ôîðóìè: Mediterranean Forum of
Physical and Rehabilitation Medicine òà North Sea
Forum of Physical and Rehabilitation Medicine.
– Íàö³îíàëüí³ òîâàðèñòâà ÔÐÌ â ªâðîï³.
– ªâðîïåéñüê³ áàãàòîíàö³îíàëüí³ æóðíàëè ÔÐÌ.
Íàïðèê³íö³, ïðåäñòàâëåíà ðîëü ªâðîïè ó ä³ÿëü-
íîñò³ ç ÔÐÌ ó âñüîìó ñâ³ò³.
ªâðîïåéñüê³ Îðãàíè ÔÐÌ
Ñåêö³ÿ Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè
ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â
(ªÑÌÑ)
Ñïåö³àëüí³ñòü áóëà îô³ö³éíî âèçíàíîþ â 1968
ðîö³, êîëè â Æåíåâ³ (Øâåéöàð³ÿ) Åêñïåðòíèé êîì-
³òåò ç ìåäè÷íî¿ ðåàá³ë³òàö³¿ Âñåñâ³òíüî¿ îðãàí³çàö³¿
îõîðîíè çäîðîâ’ÿ îãîëîñèâ ïðî ³ñíóâàííÿ íîâî¿ ìå-
äè÷íî¿ äèñöèïë³íè: Ô³çè÷íà ìåäèöèíà òà ðåàá³ë³òà-
ö³ÿ1,2. ×åðåç òðè ðîêè, ó 1971 ðîö³, ªÑÌÑ ñõâàëè-
ëà ñòâîðåííÿ Ñåêö³¿ ï³ä öèì ³ì’ÿì. Á³ëüøå
³ñòîðè÷íèõ äåòàëåé ðîçâèòêó ÔÐÌ òà ñòâîðåííÿ
Ñåêö³¿ ÔÐÌ ªÑÌÑ áóëî îïèñàíî â Ðîçä³ë³ 4 âèùå.
Ç 2001 ðîêó Ñåêö³ÿ áóëà ðåîðãàí³çîâàíà äëÿ îáñëó-
ãîâóâàííÿ ÷èñëåííèõ ïîòðåá ñïåö³àëüíîñò³ â ðàì-
êàõ ªâðîïåéñüêîãî Ñîþçó3 (www.euro-prm.org).
Âîíà ïîä³ëÿëàñÿ íà òðè êîì³òåòè (Ìàëþíîê 1):
– Ðàäà (Êîì³òåò ç íàâ÷àííÿ òà îñâ³òè ç ïèòàíü
ÔÐÌ)
– Êîì³òåò êë³í³÷íèõ ñòîñóíê³â (äëÿ âèçíà÷åííÿ òà
àêðåäèòàö³¿ ÿêîñò³ êë³í³÷íî¿ äîïîìîãè ó ÔÐÌ)
Ìàëþíîê 1. ijÿëüí³ñòü Ñåêö³¿ ÔÐÌ ªÑÌÑ
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
– Êîì³òåò ïðîôåñ³éíî¿ ïðàêòèêè (äëÿ âèçíà÷åííÿ
òà çàõèñòó Ñôåðè êîìïåòåíòíîñòåé ë³êàð³â
ÔÐÌ).
Ðàäà òà íàâ÷àííÿ ó ÔÐÌ
Ç 1991 ðîêó îñâ³òí³ ñòîñóíêè Ñåêö³¿ áóëè íàäàí³
íîâîñòâîðåíîìó êîëåäæó Europeenne College de
Medecine Physique et de Readaptation Fonctionnelle,
ùîá âèñòóïàòè ó ÿêîñò³ ªâðîïåéñüêî¿ Ðàäè, â³äïî-
â³äíî äî ïîëîæåíü ç ï³äãîòîâêè ñïåö³àë³ñò³â ªÑÌÑ.
Êîð³ííÿ ïî÷àòêó íàâ÷àííÿ òðîõè â³äð³çíÿþòüñÿ â
êîæí³é êðà¿í³, àëå, íåçâàæàþ÷è íà ð³çí³ òî÷êè âõî-
äó äî ïðîãðàìè ï³äãîòîâêè ñïåö³àë³ñò³â, íàâ÷àëü-
íèé ïëàí íà êîíòèíåíò³ ìຠçíà÷íó ñõîæ³ñòü. ªâðî-
ïåéñüêà Ðàäà ÔÐÌ ìຠçàâäàííÿ ãàðìîí³çóâàòè
íàâ÷àííÿ ñïåö³àë³ñò³â ó ªâðîï³, ùî ï³äòðèìóºòüñÿ
Áàçåëüñüêîþ äåêëàðàö³ºþ òà íàñòóïíèìè äîêó-
ìåíòàìè ªÑÌÑ4 òà âçÿëà íà ñåáå íàñòóïí³ ôóíêö³¿:
– ªâðîïåéñüêèé ³ñïèò äëÿ âèçíàííÿ íàâ÷àííÿ
ñïåö³àë³ñò³â ç ïîäàëüøèì îòðèìàííÿì ñòàòóñó
«fellow»;
– Áåçïåðåðâíà ìåäè÷íà îñâ³òà òà áåçïåðåðâíèé
ïðîôåñ³éíèé ðîçâèòîê, ùî âèêîðèñòîâóºòüñÿ äëÿ
ùîäåñÿòèð³÷íîãî ï³äòâåðäæåííÿ fellowship;
– Âèçíàííÿ ºâðîïåéñüêèõ òðåíåð³â òà íàâ÷àëüíèõ
öåíòð³â øëÿõîì â³çèò³â íà ì³ñöÿ.
ʳíöåâîþ ìåòîþ ö³º¿ ãàðìîí³çàö³¿ º ï³äãîòîâêà
ñïåö³àë³ñò³â, ÿê³ ìîæóòü ïðàöþâàòè â ð³çíèõ ºâðî-
ïåéñüêèõ ñèñòåìàõ îõîðîíè çäîðîâ’ÿ, ³ çàáåçïå÷åí-
íÿ ìîæëèâîñò³ íàö³îíàëüíèì ìåäè÷íèì îðãàíàì /
ðîáîòîäàâöÿì âèçíàííÿ çíàíü òà äîñâ³äó ñïåö³-
àë³ñò³â, ÿê³ ïðîéøëè íàâ÷àííÿ â ³íø³é ÷àñòèí³ ªâðî-
ïè. Âñ³ àñïåêòè Ñåêö³¿ òà Ðàäè, âêëþ÷àþ÷è íà-
â÷àëüíèé ïëàí ñïåö³àëüíîñò³, ìîæíà îòðèìàòè íà
âåá-ñàéò³ Ñåêö³¿ çà àäðåñîþ www.euro-prm.org.
Êîì³òåò êë³í³÷íèõ ñòîñóíê³â (ÊÊÑ)
çàéìàºòüñÿ ïèòàííÿìè ÿêîñò³ ïîñëóã ÔÐÌ
³äïîâ³äíî äî äåêëàðàö³é ªÑÌÑ5-7 öåé êîì³òåò
âñòàíîâëþº ïðîöåäóðó ªâðîïåéñüêî¿ Àêðåäèòàö³¿
ïðîãðàì ç äîïîìîãè ÔÐÌ (ïðîãîëîñîâàíî¿ ó 2004
ðîö³)8. Íå áàçóþ÷èñü íà þðèäè÷íèõ çîáîâ’ÿçàííÿõ
àáî ô³íàíñîâèõ ïåðåâàãàõ, ºäèíîþ ìåòîþ ö³º¿ àê-
ðåäèòàö³¿ º îçíàéîìëåííÿ ëþäåé ó âñ³é ªâðîï³ ç
ÿê³ñòþ ïîñëóã ÔÐÌ, ùî ïðîïîíóþòüñÿ ó ªâðîï³, òà
ñòâîðåííÿ ºâðîïåéñüêî¿ êóëüòóðè ÿêîñò³ ÔÐÌ.
Ïðîöåäóðà àêðåäèòàö³¿ ñïî÷àòêó áóëà çàäóìàíà, ÿê
ïðîñòèé çàñ³á âèáîðó ïðîãðàì äîïîìîãè, ÿê³ â³äïî-
â³äàþòü ïåâí³é ê³ëüêîñò³ âèìîã, çîêðåìà îðãàí³çà-
ö³éíèõ âèìîã. Ïðîöåäóðà áóëà çàñíîâàíà íà îíëàéí
îïèòóâàëüíèêó, ðîçì³ùåíîìó íà âåá-ñàéò³ ÔÐÌ
ªÑÌÑ, ÿêèé ïîò³ì ìàâ áóòè ïðåäñòàâëåíèé ì³æíà-
ðîäíîìó æóð³, ùî ñêëàäàëîñü ç ï’ÿòüîõ ÷ëåí³â.
Ïèòàííÿ ñòîñóâàëèñü ö³ëüîâî¿ àóäèòî𳿠ïðîãðàìè,
ö³ëåé òà íàóêîâèõ îñíîâ, ðîë³ ë³êàðÿ ÔÐÌ, çàñîá³â
83
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ðåàë³çàö³¿, îðãàí³çàö³¿ êîìàíäè òà îö³íþâàííÿ ðå-
çóëüòàò³â. Çà 2 ðîêè ï³ëîòíî¿ ôàçè áóëè àêðåäèòî-
âàí³ 13 ïðîãðàì. ϳñëÿ äåê³ëüêîõ âèñíîâê³â ï³ëîò-
íî¿ ôàçè äî ñèñòåìè îïèòóâàëüíèê³â áóëè âíåñåí³
êîðåêòèâè, ÿê³ ïåðåâàæíî ñòîñóâàëèñü ïðîñòîòè
òà ôàêòè÷íîãî îïèñó ïðîãðàìè, ùî øâèäêî ñòàëî
á³ëüø âàæëèâèì, í³æ ùîñü ³íøå ó ôîðìóâàíí³ äóì-
êè æóð³. «Ïðîãðàìà äîïîìîãè ÔÐÌ» – ñòðóêòóðíà
îäèíèöÿ äëÿ îïèñó ä³ÿëüíîñò³ íàøî¿ äèñöèïë³íè,
îö³íêè ðåçóëüòàò³â òà ïåðåìîâèí ùîäî ô³íàíñóâàí-
íÿ. Ïðîãðàìè, ÿê³ âæå áóëè àêðåäèòîâàí³, ³ âñþ
³íôîðìàö³þ ïðî íîâó ïðîöåäóðó àêðåäèòàö³¿ ìîæíà
çíàéòè îíëàéí íà ñàéò³ www.euro-prm.org. Êð³ì
òîãî, ïîñò³éíèì ïðîöåñîì â ÊÊÑ º âèçíà÷åííÿ ªâðî-
ïåéñüêèõ ì³í³ìàëüíèõ âèìîã äî êë³í³÷íî¿ ïðàêòèêè.
Êîì³òåò ïðîôåñ³éíî¿ ïðàêòèêè (ÊÏÏ)
çàéìàºòüñÿ ïèòàííÿìè ñôåðè
êîìïåòåíòíîñòåé, ïîâ’ÿçàíî¿ ç ÔÐÌ
Îñíîâíîþ ìåòîþ ÊÏÏ áóëî ãàðàíòóâàííÿ
ºäèíî¿ îô³ö³éíî âèçíàíî¿ íàçâè ñïåö³àëüíîñò³
“Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà” â ªâðîï³.
Âèðàç “ô³çè÷íà ³ ðåàá³ë³òàö³éíà ìåäèöèíà” àáî
äóæå áëèçüêèé åêâ³âàëåíò îô³ö³éíî âèêîðèñòî-
âóºòüñÿ ó âñ³õ êðà¿íàõ ªâðîïè. Íà æàëü, Äèðåêòè-
âà 2005/36 / ªÑ ªâðîïåéñüêîãî Ïàðëàìåíòó òà
Ðàäè â³ä 7 âåðåñíÿ 2005 ð. “Ïðî âèçíàííÿ ïðîôåñ³é-
íèõ êâàë³ô³êàö³é”9 âèêîðèñòîâóº òåðì³í “ô³ç³îòåðà-
ï³ÿ”. Íà ïðîõàííÿ ÊÏÏ, ªÑÌÑ ñòåæèâ çà öèì
ïèòàííÿì, ùîá ïåðåêîíàòèñü, ùî ªâðîïåéñüêà
êîì³ñ³ÿ ïðèéìå òåðì³í “ô³çè÷íà òà ðåàá³ë³òàö³éíà
ìåäèöèíà”, ï³ñëÿ çì³íåííÿ ñòàðî¿ Äèðåêòèâè íà
íîâó ó 2013 ðîö³ ùîäî âèçíàííÿ ïðîôåñ³îíàëüíèõ
êâàë³ô³êàö³é òà íàçâ ìåäè÷íèõ ñïåö³àëüíîñòåé. Çà
íîâå âèçíà÷åííÿ ÔÐÌ áóëî ïðîãîëîñîâàíî íà Ãå-
íåðàëüí³é Àñàìáëå¿ ªÑÌÑ ó ì. Àíòàë³ÿ (Òóðå÷-
÷èíà) ó æîâòí³ 2003 ðîêó. Êð³ì òîãî, çàâäÿêè
ñï³ëüíèì ä³ÿì íàö³îíàëüíèõ äåëåãàò³â Ðàäè ªÑÌÑ,
íàøà Ñåêö³ÿ çìîãëà îòðèìàòè ãîëîñ çà ïîïðàâêó
äî ªâðîïåéñüêîãî âèçíà÷åííÿ Ìåäè÷íîãî Àêòó,
äîäàâøè ñëîâà “ôóíêö³îíóâàííÿ”, “ðåàá³ë³òàö³é-
íèé” òà “åòè÷íèé”10. ϳä ïîøòîâõîì í³ìåöüêèõ,
øâåéöàðñüêèõ òà àâñòð³éñüêèõ äåëåãàò³â, Ñåêö³ÿ
ÔÐÌ ªÑÌÑ âèð³øèëà çàîõîòèòè âèêîðèñòàííÿ
̳æíàðîäíî¿ êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ. îáìå-
æåííÿ æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ) ó
êë³í³÷í³é ïðàêòèö³ (Ðåíí, Ôðàíö³ÿ, 30 áåðåçíÿ 2007).
Ðîáî÷à ãðóïà ç öüîãî ïèòàííÿ áóëà ñòâîðåíà ñï³ëü-
íî ç ªâðîïåéñüêèì òîâàðèñòâîì ÔÐÌ (ªÒÔÐÌ)11.
ßê ò³ëüêè ÊÏÏ áóâ ñòâîðåíèé ó 2001 ðîö³, éîãî
÷ëåíè ïî÷àëè ïèñàòè äðóãó Á³ëó Êíèãó, ïåðåãëÿ-
íóâøè ïåðøó Á³ëó Êíèãó ïðî ÔÐÌ â ªâðîï³, ÿêó
áóëî îïóáë³êîâàíî â 1989 ðîö³ òðüîìà ºâðîïåéñü-
êèìè îðãàí³çàö³ÿìè (ªâðîïåéñüêà ôåäåðàö³ÿ ÔÐÌ,
ªâðîïåéñüêà àêàäåì³ÿ òà Ñåêö³ÿ ªÑÌÑ). Íîâà
84 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Á³ëà Êíèãà ïðèçíà÷åíà äëÿ îïèñó ñòàíó ñïåö³àëü-
íîñò³ ÔÐÌ ó âñ³õ éîãî àñïåêòàõ: íàçâà, âèçíà÷åí-
íÿ, çì³ñò òà îðãàí³çàö³ÿ ïðîãðàì ïî÷àòêîâî¿ îñâ³-
òè, äåìîãðàô³ÿ, áåçïåðåðâíà îñâ³òà, íàóêîâ³
äîñë³äæåííÿ òà ïóáë³êàö³¿. ¯¿ ñï³ëüíî ï³äãîòóâàëè
Ñåêö³ÿ ÔÐÌ ªÑÌÑ òà ªâðîïåéñüêèé êîëåäæ
(Ðàäà) òà ªâðîïåéñüêà àêàäåì³ÿ ðåàá³ë³òàö³éíî¿
ìåäèöèíè ñï³ëüíî ç ªâðîïåéñüêèì òîâàðèñòâîì
ô³çè÷íî¿ ³ ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ªÒÔÐÌ) òà
âîíà áóëà îïóáë³êîâàíà ñï³ëüíî Journal of
Rehabilitation Medicine12 òà Europa Medicophysica13.
Öå, òðåòº âèäàííÿ ïðèçíà÷åíå äëÿ äåìîíñòðàö³¿
ðîçâèòêó ÔÐÌ â ªâðîï³.
×ëåíè
Ïîâíå ÷ëåíñòâî ìàþòü 28 ÷ëåí³â ªâðîïåéñüêî-
ãî Ñîþçó ðàçîì ç Øâåéöàð³ºþ, Íîðâå㳺þ òà ²ñëàí-
䳺þ. ²çðà¿ëü, Ñåðá³ÿ òà Òóðå÷÷èíà º àñîö³éîâàíè-
ìè ÷ëåíàìè. Äåÿê³ ³íø³ ºâðîïåéñüê³ êðà¿íè º
ñïîñòåð³ãà÷àìè (Ìîíòåíåãðî, Ìàêåäîí³ÿ, Áîñí³ÿ ³
Ãåðöåãîâèíà, Ãðóç³ÿ, ³ðìåí³ÿ, Ðîñ³ÿ, Óêðà¿íà). Ó
âñ³õ öèõ êðà¿íàõ íàë³÷óºòüñÿ ïîíàä 23000 ï³äãîòîâ-
ëåíèõ ñïåö³àë³ñò³â òà ðåçèäåíò³â. Îòæå, ªÑÌÑ ìàº
âåëèêå çàâäàííÿ çàáåçïå÷èòè â³äïîâ³äíèé çâ’ÿçîê
ì³æ óñ³ìà öèìè êðà¿íàìè íà ºâðîïåéñüêîìó ð³âí³.
ʳëüê³ñòü ë³êàð³â ÔÐÌ ó ð³çíèõ êðà¿íàõ ªâðîïè
çíà÷íî â³äð³çíÿºòüñÿ. Çàãàëüíà ñòðóêòóðà ïîñëóã
ç ÔÐÌ ïî âñ³é ªâðîï³ àíàëîã³÷íà, íåçâàæàþ÷è íà
ð³çíèöþ ì³æ ñèñòåìàìè îõîðîíè çäîðîâ’ÿ. Ïðîïî-
çèö³¿ ùîäî êë³í³÷íèõ ñòàíäàðò³â îá’ºäíóþòüñÿ ï³ä
÷àñ öüîãî ïðîöåñó ó ôîðì³ ïðàêòèêè, ùî áàçóºòü-
ñÿ íà “ãðóïàõ, ïîâ’ÿçàíèõ ç³ çäîðîâ’ÿì”. Ïðèêëà-
äîì ö³º¿ îñòàííüî¿ ä³¿ º ñòâîðåííÿ ªâðîïåéñüêèõ
Ñòàíäàðò³â Ïðàêòèêè äëÿ ïàö³ºíò³â ó ï³äãîñòðèõ
çàêëàäàõ, ªâðîïåéñüêî¿ êàðòêè äëÿ ïàö³ºíò³â ç âå-
ãåòàòèâíîþ äèçðåôëåêñ³ºþ, à òàêîæ åëåêòðîííà
êíèãà ç³ ñôåðè êîìïåòåíòíîñòåé, ÷àñòèíà I òà ÷à-
ñòèíà II, îñòàííÿ çàðàç ðîçðîáëÿºòüñÿ.
ªâðîïåéñüêå òîâàðèñòâî ô³çè÷íî¿ òà
ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ªÒÔÐÌ)
(www.esprm.net)
²ñòîðè÷í³ äåòàë³ ïðåäñòàâëåí³ ó ðîçä³ë³ 4.
̳ñ³ºþ ªÒÔÐÌ º:
– Áóòè ïðîâ³äíèì íàóêîâèì ªâðîïåéñüêèì òîâà-
ðèñòâîì ë³êàð³â ó ãàëóç³ ô³çè÷íî¿ òà ðåàá³ë³òà-
ö³éíî¿ ìåäèöèíè;
– ϳäâèùèòè ð³âåíü çíàíü ïðî îñíîâè òà óïðàâ-
ë³ííÿ àêòèâí³ñòþ, ó÷àñòþ òà êîíòåêñòóàëüíè-
ìè ôàêòîðàìè îñ³á, ÿê³ çàçíàþòü àáî ìîæóòü
çàçíàòè îáìåæåíü æèòòºä³ÿëüíîñò³;
– Ïîêðàùèòè òà ï³äòðèìóâàòè ì³öíèé çâ’ÿçîê ì³æ
äîñë³äíèöüêîþ òà êë³í³÷íîþ ïðàêòèêîþ ó ÔÐÌ.
ªÒÔÐÌ ìຠ÷ëåíñòâî ÿê äëÿ îêðåìèõ ÷ëåí³â,
ÿê³ º ë³êàðÿìè ÔÐÌ, òàê ³ äëÿ íàö³îíàëüíèõ òîâà-
¹2(2) *2018

ðèñòâ ÔÐÌ. Íà ñüîãîäí³øí³é äåíü (2017) îñòàíí³
ñêëàäàþòü 35 ÷ëåí³â (Àâñòð³ÿ, Áåëüã³ÿ, Áîëãàð³ÿ,
Õîðâàò³ÿ, ʳïð, Äàí³ÿ, Åñòîí³ÿ, Ô³íëÿíä³ÿ, Ôðàíö³ÿ,
Ìàêåäîí³ÿ, Ãðóç³ÿ, ͳìå÷÷èíà, Ãðåö³ÿ, Óãîðùèíà,
²ðëàíä³ÿ, ²òàë³ÿ, Ëàòâ³ÿ, Ëèòâà, Ëþêñåìáóðã, Ìîí-
òåíåãðî, Íîðâåã³ÿ, Ïîðòóãàë³ÿ, Ïîëüùà, Áîñí³ÿ ³
Ãåðöåãîâèíà, Ðóìóí³ÿ, Ñåðá³ÿ, Ñëîâåí³ÿ, ²ñïàí³ÿ,
Øâåö³ÿ, Øâåéöàð³ÿ, ͳäåðëàíäè, Òóðå÷÷èíà, Ðîñ³ÿ,
Óêðà¿íà). Âîíà òàêîæ ìຠñï³âïðàöþþ÷è òîâàðè-
ñòâà, ùî íàäõîäÿòü ³ç êðà¿í, ïîçà ìåæàìè ªâðîïè
(²çðà¿ëü, Éîðäàí³ÿ) àáî ñòðóêòóðà ÿêèõ íå â³äïî-
â³äຠÑòàòóòàì òà íîðìàì ªÒÔÐÌ (Ìàëüòà).
Áóëè ñòâîðåí³ íàñòóïí³ Ñïåö³àëüí³ íàóêîâ³ êî-
ì³òåòè (SISC): (1) Ãðîìàäñüêå çäîðîâ’ÿ, (2) Îðòå-
çóâàííÿ òà ïðîòåçóâàííÿ, (3) Íàñòàíîâè, (4) Ëþäè
ç áîëåì òà îáìåæåííÿìè æèòòºä³ÿëüíîñò³, (5)
Ëþäè ç Ïàðê³íñîíîì / ðóõîâèìè ðîçëàäàìè, (6)
Ëþäè ç ÷åðåïíî-ìîçêîâèìè òðàâìàìè, (7) Ëþäè
ç ì’ÿçîâî-ñêåëåòíèìè ðîçëàäàìè, (8) Ñïîðòèâí³
ñòîñóíêè, (9) Ðîáîòè â ðåàá³ë³òàö³¿, (10) ÔÐÌ ó
ë³òí³õ ëþäåé, (11) Äîêàçîâà ìåäèöèíà, (12) Ëþäè
ç òðàâìàìè ñïèííîãî ìîçêó, (13) Ëþäè ç ³íñóëü-
òîì, (14) Óëüòðàçâóê ó ÔÐÌ òà (15) Ëþäè ç ðîç-
ëàäàìè ïåðèôåðè÷íî¿ íåðâîâî¿ ñèñòåìè. Íàñòóïí³
Êîíãðåñè, ïðîâåäåí³ ªâðîïåéñüêèì òîâàðèñòâîì
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè, áóëè îñíîâ-
íèìè ïîä³ÿìè, íà ÿêèõ ïðîïàãóâàëàñü ä³ÿëüí³ñòü
òîâàðèñòâà â äîñë³äíèöüê³é ãàëóç³: ³äåíü (2004),
Ìàäðèä (2006), Áðþããå (2008), Âåíåö³ÿ (2010),
Ñàëîí³êè (2012), Ìàðñåëü (2014) òà Åñòîð³ë (2016).
Êð³ì òîãî, ðîëü Òîâàðèñòâà çì³öíþºòüñÿ ó çâ’ÿç-
êó ç ¿¿ ñï³âïðàöåþ ç ³íøèìè ªâðîïåéñüêèìè Îðãà-
íàìè ÔÐÌ, ÿê³ ïðàöþþòü íà ºâðîïåéñüêîìó ð³âí³
ó ãàëóç³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè, à
òàêîæ íà ñâ³òîâîìó ð³âí³ ç ISPRM (International
Society of PRM).
Acad mie M dicale Europ enne de M decine
de R adaptation / ªâðîïåéñüêà àêàäåì³ÿ
ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ªÀÐÌ,
www.aemr.eu)
²ñòîðè÷í³ äåòàë³ ùîäî Àêàäå쳿 ïðåäñòàâëåí³ â
ðîçä³ë³ 4.
̳ñ³ºþ º:
– ïîêðàùèòè âñ³ àñïåêòè ðåàá³ë³òàö³¿ ëþäåé ç îá-
ìåæåííÿìè æèòòºä³ÿëüíîñò³;
– áóòè îð³ºíòèðîì ó íàóêîâèõ, îñâ³òí³õ òà ãóìà-
í³òàðíèõ àñïåêòàõ ÔÐÌ;
– çàéìàòèñÿ ìîðàëüíèìè òà åòè÷íèìè äåáàòàìè;
– îáì³íþâàòèñü ³íôîðìàö³ºþ, ùî âèçíà÷ຠîá-
ëàñòü ðåàá³ë³òàö³¿ òà ¿¿ òåðì³íîëîã³þ;
– çàáåçïå÷èòè, ùîá îñâ³òà â ðåàá³ë³òàö³¿ áóëà
÷àñòèíîþ á³îãðàô³¿;
– ï³äòðèìàòè òà äîïîìîãòè ó âäîñêîíàëåíí³ äîñ-
ë³äæåíü â ðåàá³ë³òàö³¿;
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 5 – ÎÐÃÀͲÇÀÖ²¯ ÔÐÌ Â ªÂÐÎϲ: ÑÒÐÓÊÒÓÐÀ ÒÀ IJßËÜͲÑÒÜ
– âïðîâàäèòè òà çàõèùàòè ïðèíöèïè ðåàá³ë³òàö³¿;
– òà ñïðèÿòè îáì³íó ðåçèäåíò³â òà ë³êàð³â ÔÐÌ
ì³æ ð³çíèìè êðà¿íàìè.
Âîíà ñêëàäàºòüñÿ ç ìàêñèìóì 50 ñòàðøèõ àêà-
äåì³÷íèõ ë³êàð³â ç óñ³º¿ ªâðîïè, à àêàäåì³êè çîñå-
ðåäæóþòüñÿ íà ãóìàí³òàðíèõ òà åòè÷íèõ ïèòàííÿõ
â ðåàá³ë³òàö³éí³é ìåäèöèí³ òà îáìåæåííÿõ æèòòº-
ä³ÿëüíîñò³. Äåÿê³ íàïðàöþâàííÿ ç åòèêè º íàñòóï-
íèìè:
1. Åòè÷í³ ïðîáëåìè, ùî âèíèêëè âíàñë³äîê á³ëüø
òðèâàëîãî âèæèâàííÿ á³ëüøî¿ ê³ëüêîñò³ ëþäåé,
ÿê³ º ö³ëêîì çàëåæíèìè òà ñâ³äîìèìè.
2. Âèÿâëåííÿ ïðîãíîçó äëÿ ïàðàë³çîâàíîãî äîðîñ-
ëîãî.
3. Åòè÷í³ ïðîáëåìè, ñïðè÷èíåí³ ñåêñóàëüí³ñòþ ó
ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³, ÿê³ ïå-
ðåáóâàþòü â ³íñòèòóö³éíèõ óñòàíîâàõ.
4. Íàñèëüñòâî òà ô³çè÷í³ âàäè, îïóáë³êîâàí³ ÿê
êîðîòêå ïîâ³äîìëåííÿ. Journal of Rehabilitation
Medicine, 2006.
5. La r adaptation m dicale des personnes g es: d fis
et challenges humains, thiques et m dico –
conomiques Commission de Prospectives.
ªÀÐÌ ââàæàº, ùî ðåàá³ë³òàö³þ ìîæíà êðàùå
çðîçóì³òè ³ ïðàêòèêóâàòè, ÿêùî º äîñòóï äî íàé-
êðàùî¿ ³íôîðìàö³¿ òà ÿêùî âèïóùåíî ñåð³þ ìîíî-
ãðàô³é. Ö³ êíèãè ìàþòü áóòè îñîáëèâî êîðèñíèìè
äëÿ ìîëîäèõ ë³êàð³â, ÿê³ ãîòóþòüñÿ äî ñåðòèô³êàö³¿
ªâðîïåéñüêîþ Ðàäîþ ç ÔÐÌ, äëÿ ñòàðøèõ ë³êàð³â,
ÿê³ ñïåö³àë³çóþòüñÿ â ÔÐÌ òà ñóì³æíèõ äèñöèïë³-
íàõ, ÿê³ øóêàþòü ³íôîðìàö³þ òà áåçïåðåðâíó ìå-
äè÷íó îñâ³òó, à òàêîæ äëÿ âñ³õ ÷ëåí³â ðåàá³ë³òà-
ö³éíî¿ êîìàíäè.
Êíèãàìè, ùî îïóáë³êîâàí³ â Êîëåêö³¿ Àêàäå쳿
Springer France º:
– La Plasticite de la Fonction Motrice / The Plasticity
of Motricity Function; by J.P. Didier. Springer. 2004;
– Sphincter Functioning / Les fonctions sphinct rien-
nes.by Amarenco G., Chantraine A. (Eds.) (2006);
– Vocational Rehabilitation by Gobelet Charles.
Franchignoni Franco (2006);
– Rehabilitation and palliation of cancer patients
(Patient care) by Hermann Delbruck (2007);
– Rethinking physical and rehabilitation Medicine -
New technologies induce new learning strategies
by Didier Jean-Pierre Bigand Emmanuel (2010);
Êð³ì òîãî, ñïåö³àëüíî îïóáë³êîâàíà êíèãà çà
ô³íàíñóâàííÿ Àêàäå쳿 “Assessment in Physical
Medicine and Rehabilitation: Views and Perspectives”
by M. Barat and F. Franchignoni áóëà âèäàíà
Maugeri Foundation Books ó 2005 ð.
Ïðîòÿãîì áàãàòüîõ ðîê³â ªÀÐÌ, ñïðÿìîâàíà íà
çàîõî÷åííÿ íîâèõ äîñë³äíèê³â, ñòâîðèëà ùîð³÷íó
ïðåì³þ Àêàäå쳿 äëÿ ïóáë³êàö³¿ â ãàëóç³ ÔÐÌ
(ï³äòðèìàíà â ìèíóëîìó Swiss Paraplegic
85
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Foundation òà îñòàíí³ìè ðîêàìè íåêîìåðö³éíîþ
Foundation for Rehabilitation Information ðàçîì ³ç
Journal of Rehabilitation Medicine). Ïðèç îô³ö³éíî
ïðèñóäæóºòüñÿ íà êîæíîìó ªâðîïåéñüêîìó Êîí-
ãðåñ³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè.
Ðåã³îíàëüí³ ôîðóìè
Ðåã³îíàëüí³ Ôîðóìè ç Ô³çè÷íî¿
òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ):
Mediterranean Forum of PRM (MFPRM) ³ Baltic
and North Sea Forum of PRM (BNF-PRM)
Ó òðàâí³ 1996 ðîêó â Ãåðö볿, ²çðà¿ëü, áóâ îðãàí³-
çîâàíèé ² Ñåðåäçåìíîìîðñüêèé Êîíãðåñ ç ÔÐÌ ï³ä
ãàñëîì “Ðåàá³ë³òàö³ÿ áåç êîðäîí³â”, ñïðÿìîâàíèé
íà ïîïóëÿðèçàö³þ ÔÐÌ ó âñüîìó ñâ³ò³ òà ÿêîñò³
æèòòÿ ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ ó
ðàéîí³ Ñåðåäçåìíîìîðñüêîãî áàñåéíó. ϳä ÷àñ
öüîãî ç’¿çäó â³äáóëîñÿ çàñ³äàííÿ ï³ä íàçâîþ: “×è º
æèòòºçäàòíèì Ñåðåäçåìíîìîðñüêå Òîâàðèñòâî
ÔÐÌ?”14,15. Áóëî âèð³øåíî îðãàí³çóâàòè ùîäâîð³-
÷íèé Ñåðåäçåìíîìîðñüêèé Êîíãðåñ, òà ²² Êîíãðåñ
áóëî îðãàí³çîâàíî â 1998 ðîö³ â Âàëåíñ³¿.
Mediterranean Forum of Physical and Rehabilitation
Medicine (MFPRM) áóëî ñòâîðåíî íà ²²² Êîíãðåñ³
â Àô³íàõ ó 2000 ðîö³, à éîãî ÷ëåíàìè º ³íäèâ³äó-
àëüí³ ë³êàð³ ÔÐÌ ³ç êðà¿í Ñåðåäçåìíîìîð’ÿ àáî
êðà¿í, ùî çíàõîäÿòüñÿ ïîðó÷ ³ç íèìè. Ç òîãî ÷àñó
Ñåðåäçåìíîìîðñüêèé Êîíãðåñ ïðîâîäèâñÿ â Ñèðà-
êóçàõ (2002), Àíòà볿 (2004), ³ëàìóð³ (2006), Ïîð-
òîðîç³ (2008), ˳ìàññîë³ (2010), Ñîððåíòî (2012),
Áóäâ³ (2013), Îëåêñàíä𳿠(2015) òà Ìàëüò³ (2017).
Áàçóþ÷èñü íà äîñâ³ä³ MFPRM, îáãîâîðåííÿ Áàë-
ò³éñüêîãî Ôîðóìó ðîçïî÷àëîñÿ ó 2003 ðîö³16. Óñ-
òàíîâ÷³ çáîðè áóëè ïðîâåäåí³ â Ðèç³ ó âåðåñí³ 2007
ðîêó, ³ áóëî ïðèéíÿòî ð³øåííÿ âêëþ÷èòè äî ôîðó-
ìó òàêîæ çîíó ϳâí³÷íîãî ìîðÿ. Áóëî âèð³øåíî, ùî
Ôîðóì áóäå áàçóâàòèñÿ íà ³íäèâ³äóàëüíîìó
÷ëåíñòâ³. Ç áåðåçíÿ 2010 Baltic and North Sea Forum
on Physical and Medical Rehabilitation (BNF-PRM)
áóâ îô³ö³éíî çàðåºñòðîâàíèé ó Ëàò⳿. Ó âåðåñí³
2009 ð. ó ³ëüíþñ³ áóëà ïðèéíÿòà ïîë³òè÷íà äåê-
ëàðàö³ÿ16, à íèí³øíÿ îðãàí³çàö³ÿ ìຠâèêîíàâ÷ó
ðàäó, íàãëÿäîâó ðàäó òà ÷îòèðè êîì³òåòè. ª äâ³
îñíîâí³ ïðè÷èíè ³ñíóâàííÿ BNF-PRM. Ïåðøà ïî-
ëÿãຠâ òîìó, ùî Ïðèáàëòèêà ³ ϳâí³÷íå ìîðå - öå
ðåã³îí ç 16 êðà¿íàìè, ùî ìàþòü ð³çí³ ìîâè òà òðà-
äèö³¿, à òàêîæ ð³çí³ ñèñòåìè îõîðîíè çäîðîâ’ÿ, ùî
ïðèçâîäèòü äî ðîçá³æíîñòåé ó ï³äõîäàõ òà ñòðàòå㳿
ðåàá³ë³òàö³¿. Äðóãîþ ïðè÷èíîþ äëÿ BNF-PRM º
ïîë³òè÷íà ³ñòîð³ÿ ðåã³îíó. ³í áóâ ïîä³ëåíèé òàê
çâàíîþ “çàë³çíîþ çàâ³ñîþ”, ³ ïðàêòè÷íî íå áóëî
îñîáèñòèõ êîíòàêò³â ì³æ êîëåãàìè, ùî æèëè íà
ð³çíèõ áîêàõ êîðäîíó, ³ òîìó íå áóëî íàóêîâîãî
ñï³ëêóâàííÿ òà îáì³íó.
86 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Î÷åâèäíî, ùî ³ñíóþòü îñíîâí³ ïðèíöèïè, ùî º
çàãàëüíèìè äëÿ MFPRM òà BNF-PRM. Îñíîâíè-
ìè ö³ëÿìè BNF-PRM òà MFPRM º16,17:
1. ñï³ëêóâàòèñÿ òà îáì³íþâàòèñÿ çíàííÿìè ó ãà-
ëóç³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè;
2. ñòâîðþâàòè òà îö³íþâàòè ïðèíöèïè ä³ÿëüíîñò³
ç ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè òà îáãî-
âîðþâàòè íàéêðàùó ïðàêòèêó;
3. ñòèìóëþâàòè ñòâîðåííÿ ìåðåæ äëÿ íàóêîâèõ
ïðîåêò³â ùîäî ð³çíèõ àñïåêò³â äîñë³äæåíü â
ðåàá³ë³òàö³¿, áàãàòîöåíòðîâèõ äîñë³äæåíü òà
ïðîåêò³â;
4. ï³äòðèìóâàòè îñâ³òó òà íàâ÷àííÿ ó ñôåð³ ÔÐÌ
òà ñïðèÿòè îáì³íó ìîëîäèìè ë³êàðÿìè òà â÷åíè-
ìè, íàïð. ïåð³îäè÷íî îðãàí³çîâóâàòè êîíãðåñè;
5. âïëèâàòè íà íàö³îíàëüí³ óðÿäè ç âêëþ÷åííÿ ïè-
òàíü ðåàá³ë³òàö³¿ äî íàö³îíàëüíî¿ ñòðàòå㳿 îõî-
ðîíè çäîðîâ’ÿ;
6. íàäàâàòè ìîæëèâ³ñòü îñîáèñòèõ êîíòàêò³â;
7. ñï³âïðàöþâàòè ç íàö³îíàëüíèìè òà ì³æíàðîäíè-
ìè íàóêîâèìè îðãàíàìè ÔÐÌ.
Ö³ äâà Ðåã³îíàëüí³ Ôîðóìè ïîøèðþþòü êóëüòó-
ðó ÔÐÌ ïîçà êîðäîíàìè ªâðîïåéñüêîãî ñï³âòîâà-
ðèñòâà. Íà ï³âäí³ äî ϳâí³÷íî¿ Àôðèêè òà Çàõ³äíî¿
À糿 (MFPRM), à íà ï³âíî÷³ - ÷åðåç êîëèøíþ “çàë³ç-
íó çàâ³ñó”, â òîìó ÷èñë³ Ðîñ³þ òà ³íø³ êðà¿íè (BNF-
PRM). Îáèäâà Ôîðóìè îðãàí³çîâóþòü íàóêîâ³ êîí-
ãðåñè18-21 òà ë³òí³ øêîëè äëÿ ðåçèäåíò³â ÔÐÌ òà
ìîëîäèõ ñïåö³àë³ñò³â. The Euro-Mediterranean PRM
Haim Ring School ïðîâîäèòüñÿ ùîðîêó â Ñèðàêó-
çàõ çà ñïðèÿííÿ SIMFER, ªÑÌÑ, ªÒÔÐÌ òà
MFPRM22. Ó ñåðïí³ 2014 ðîêó áóëà îðãàí³çîâàíà
ïåðøà Ðèçüêà ë³òíÿ øêîëà. “European Journal of
PRM” ³ç ï³äçàãîëîâêîì “Mediterranean Journal of
PRM” º îô³ö³éíèì æóðíàëîì MFPRM, à Journal of
Rehabilitation Medicine º îô³ö³éíèì æóðíàëîì BNF-
PRM. Âåá-ñàéò MFPRM - www.mfprm.org; âåá-
ñàéò BNF-PRM - www.bnfprm.org 2. MFPRM òà
BNF-PRM º óí³êàëüíèìè òà ïîñò³éíî çðîñòàþ÷è-
ìè òîâàðèñòâàìè ÔÐÌ, ÿê³ ä³þòü íà äîáðîâ³ëüí³é
îñíîâ³ äëÿ äîñÿãíåííÿ íàóêîâî¿, êóëüòóðíî¿ òà ãó-
ìàí³òàðíî¿ ì³ñ³¿: ðîçðîáêà òà ãàðìîí³çàö³ÿ “Ðåàá³-
ë³òàö³¿ çà êîðäîíîì”. Ö³ Ôîðóìè ñïðÿìîâàí³ íà
ñòâîðåííÿ ìîñò³â âçàºìîðîçóì³ííÿ òà ñï³âïðàö³
ì³æ ªâðîïîþ òà ³íøèìè êðà¿íàìè, ùî ñïðèÿþòü
êðàùèì òà ìèðíèì ðåã³îíàì “áåç êîðäîí³â”.
Íàö³îíàëüí³ òîâàðèñòâà Ô³çè÷íî¿
òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³
Ó ªâðîï³ íàö³îíàëüí³ òîâàðèñòâà â³ä³ãðàþòü
îñíîâíó ðîëü ó ðîçâèòêó Ô³çè÷íî¿ òà Ðåàá³ë³òàö³é-
íî¿ Ìåäèöèíè. ªâðîïåéñüê³ Îðãàíè ³ñíóþòü äëÿ
ï³äòðèìêè íàö³îíàëüíèõ òîâàðèñòâ ó ¿õíüîìó çàâ-
äàíí³ ùîäî ðîçâèòêó ÔÐÌ â åêîíîì³ö³ îõîðîíè
¹2(2) *2018

çäîðîâ’ÿ ñâî¿õ êðà¿í, ïðîôåñ³éíèõ îðãàí³çàö³ÿõ òà
àêàäåì³÷íèõ ñòðóêòóðàõ.
Êîæíà ºâðîïåéñüêà êðà¿íà ìຠíàö³îíàëüíå òî-
âàðèñòâî ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè
ç ð³çíèìè íàçâàìè òà ð³çíèì ³ñòîðè÷íèì ïîõîäæåí-
íÿì. Ðîëü ªâðîïåéñüêèõ Îðãàí³â ïîëÿãຠâ òîìó,
ùîá ãàðìîí³çóâàòè ïðàêòèêó ÔÐÌ òà îñâ³òó â
ªâðîï³ òà íàö³îíàëüíèõ òîâàðèñòâàõ, âïðîâàäæó-
âàòè ºâðîïåéñüê³ ñòàíäàðòè â³äïîâ³äíî äî ¿õ ñïå-
öèô³÷íîãî òà ì³ñöåâîãî äîñâ³äó.
Ïðîáëåìà âèíèêàº, êîëè â îäí³é êðà¿í³ ³ñíóº
á³ëüø í³æ îäíå òîâàðèñòâî ÔÐÌ, òà ³íîä³ âàæêî
çíàéòè äåëåãàò³â äëÿ ¿õ ïðåäñòàâëåííÿ.
Êð³ì òîãî, íàö³îíàëüí³ òîâàðèñòâà îðãàí³çî-
âóºòüñÿ ïî-ð³çíîìó â ð³çíèõ êðà¿íàõ: ó äåÿêèõ º îäíå
òîâàðèñòâî, ÿêå îõîïëþº âñ³ àñïåêòè (íàïð. ͳ-
äåðëàíäè).  ³íøèõ ³ñíóþòü ð³çí³ òîâàðèñòâà (íàïð.
²òàë³ÿ, Áåëüã³ÿ, Ôðàíö³ÿ), ùî îõîïëþþòü â³äïîâ³äíî
íàóêîâ³, ïðîôåñ³éí³ òà ñèíîäàëüí³ ïèòàííÿ.
Ðîëü ªâðîïåéñüêèõ Îðãàí³â ïîëÿãຠâ òîìó,
ùîá ãàðìîí³çóâàòè ïðàêòèêó ÔÐÌ òà îñâ³òó ïî âñ³é
ªâðîï³ òà íàö³îíàëüíèõ ñóñï³ëüñòâàõ äëÿ ïðîâåäåí-
íÿ ³ìïëåìåíòàö³¿ ºâðîïåéñüêèõ ñòàíäàðò³â â³äïî-
â³äíî äî ¿õ êîíêðåòíîãî ì³ñöåâîãî äîñâ³äó.
Óñ³ íàö³îíàëüí³ òîâàðèñòâà êðà¿í-÷ëåí³â ìàþòü
ñâî¿õ äåëåãàò³â ó Ñåêö³¿ òà Ðàä³ ÔÐÌ ªÑÌÑ òà
áåðóòü ó÷àñòü ó ðåãóëÿðíèõ ãåíåðàëüíèõ àñàìá-
ëåÿõ, ÿê³ îðãàí³çîâóþòüñÿ äâ³÷³ íà ð³ê.
Çàçâè÷àé ïðîòÿãîì òîãî æ òèæíÿ â³äáóâàºòüñÿ
çóñòð³÷ äåëåãàò³â ªÒÔÐÌ, äå íà àñàìáëå¿ ïðè-
ñóòí³ ïðåäñòàâíèêè âñ³õ òîâàðèñòâ - ÷ëåí³â òà ³íäè-
â³äóàëüí³ ÷ëåíè.
×ëåíè «ªâðîïåéñüêî¿ àêàäå쳿 ðåàá³ë³òàö³éíî¿
ìåäèöèíè» íå ïîâ’ÿçàí³ áåçïîñåðåäíüî ç íàö³îíàëü-
íèìè òîâàðèñòâàìè, àëå äîëó÷àþòüñÿ íàïðÿìó
ï³ñëÿ ðîçãëÿäó Àêàäå쳺þ ³íäèâ³äóàëüíî¿ çàÿâè.
ÔÐÌ âèçíàºòüñÿ îñíîâíîþ ñëóæáîþ â êîæí³é
ç äåðæàâ-÷ëåí³â Âåëèêîãî ºâðîïåéñüêîãî ïðîñòî-
ðó, à íîâ³ àñîö³éîâàí³ êðà¿íè òà êðà¿íè-ñïîñòåð³ãà÷³
òàêîæ ïðèéìàþòü ò³ ñàì³ ïðèíöèïè.
Á³ëüø³ñòü íàö³îíàëüíèõ òîâàðèñòâ ñïåö³àë³ñò³â
Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³ º
÷ëåíàìè ªâðîïåéñüêîãî òîâàðèñòâà ÔÐÌ. Íà-
ñïðàâä³ îäí³ºþ ç ö³ëåé ªâðîïåéñüêî¿ ôåäåðàö³¿
ô³çè÷íî¿ ìåäèöèíè òà ðåàá³ë³òàö³¿, ÿêà áóëà çàñíî-
âàíà â 1963 ðîö³, áóëà ïîïóëÿðèçàö³ÿ â êîæí³é ºâðî-
ïåéñüê³é êðà¿í³ íàö³îíàëüíîãî íàóêîâîãî òîâàðèñòâà
ÔÐÌ òà îðãàí³çàö³¿, ÿêà çàõèùຠçàãàëüí³ ³íòåðåñè
ë³êàð³â ÔÐÌ. Ó 2003 ðîö³, êîëè áóëà çàñíîâàíî
ªÒÔÐÌ, ÿê ïðàâîíàñòóïíèöÿ ªâðîïåéñüêî¿ ôåäå-
ðàö³¿ ÔÐÌ, áóâ 21 ÷ëåí – íàö³îíàëüíå òîâàðèñòâî.
Ó äåÿêèõ êðà¿íàõ, ÿê Ëàòâ³ÿ òà Òóðå÷÷èíà, º á³ëüøå
í³æ îäíå Íàö³îíàëüíå òîâàðèñòâî ë³êàð³â ÔÐÌ. Öå
äóæå îáíàä³éëèâî òà ³íôîðìàòèâíî ñòîñîâíî çðî-
ñòàþ÷îãî âïëèâó ªÒÔÐÌ, ùî çðîñòຠçàö³êàâ-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 5 – ÎÐÃÀͲÇÀÖ²¯ ÔÐÌ Â ªÂÐÎϲ: ÑÒÐÓÊÒÓÐÀ ÒÀ IJßËÜͲÑÒÜ
ëåí³ñòü ÍÒ ùîäî ïðèºäíàííÿ äî ªÒÔÐÌ. Ó 2015 ð.
ïðèºäíàëèñü òîâàðèñòâà Ðîñ³¿ òà Óêðà¿íè, ÿê³ îõîï-
ëþþòü âåëèêó ê³ëüê³ñòü “ë³êàð³â-ô³ç³îòåðàïåâò³â”
òà ³íøèõ ïîâ’ÿçàíèõ ìåäè÷íèõ ñïåö³àë³çàö³é, ç
íàâ÷àëüíèìè ïðîãðàìàìè, ùî â³äð³çíÿþòüñÿ â³ä
ºâðîïåéñüêî¿ ñïåö³àë³çàö³¿ ÔÐÌ. Ç ìåòîþ ãàðìî-
í³çàö³¿ íàâ÷àëüíî¿ ïðîãðàìè ç ñïåö³àë³çàö³¿, â íèõ
â³äáóâàºòüñÿ ïåðåõ³ä íà ºâðîïåéñüêó ìîäåëü
ñïåö³àëüíîñò³ çà ï³äòðèìêè Ñåêö³¿ òà Ðàäè ÔÐÌ
ªÑÌÑ.
ªÒÔÐÌ âêëþ÷ຠíå ò³ëüêè íàö³îíàëüí³ òîâàðè-
ñòâà êðà¿í-÷ëåí³â ªâðîïåéñüêîãî Ñîþçó, àëå, ÿê öå
âèäíî ç ïåðåë³êó ÷ëåí³â, äî ¿õ ñêëàäó âõîäÿòü ìàé-
æå âñ³ ºâðîïåéñüê³ êðà¿íè.
Ó 2016 ðîö³ ªÒÔÐÌ íàë³÷óâàâ 17238 àêòèâíèõ
÷ëåí³â íàö³îíàëüíèõ òîâàðèñòâ. ³äñîòîê ë³êàð³â
ÔÐÌ, ÿê³ º ÷ëåíàìè ¿õ íàö³îíàëüíîãî òîâàðèñòâà,
ð³çíèòüñÿ ì³æ êðà¿íàìè. Íàïðèêëàä, ó ͳìå÷÷èí³
ëèøå 21% ë³êàð³â ÔÐÌ º ÷ëåíàìè ͳìåöüêîãî òî-
âàðèñòâà ÔÐÌ, òîä³ ÿê ó ²òà볿 öåé â³äñîòîê äîñÿ-
ãຠ80% òà 95% ó Âåëèê³é Áðèòàí³¿. Ó äåÿêèõ íà-
ö³îíàëüíèõ òîâàðèñòâàõ òàêîæ º ³íø³ ìåäè÷í³
ñïåö³àë³ñòè òà ³íø³ ôàõ³âö³, ÿê ïîâí³ àáî àñîö³éîâàí³
÷ëåíè (íàïð. Àâñòð³ÿ, ×åõ³ÿ, Óãîðùèíà, ²ðëàíä³ÿ,
Ïîëüùà, Ðîñ³ÿ, Ñëîâà÷÷èíà, Øâåéöàð³ÿ, Âåëèêà
Áðèòàí³ÿ òà Ìàëüòà)
 ºâðîïåéñüêèõ êðà¿íàõ íàë³÷óºòüñÿ 20655
ë³êàð³â ÔÐÌ. ʳëüê³ñòü ë³êàð³â ÔÐÌ ïî âñ³é ªâðîï³
çíà÷íî â³äð³çíÿºòüñÿ, à â òàáëèö³ ² ïðåäñòàâëåí³
äåìîãðàô³÷í³ äàí³. ʳëüê³ñòü ë³êàð³â ÔÐÌ íà 100000
æèòåë³â òàêîæ êîëèâàºòüñÿ â ð³çíèõ êðà¿íàõ - â³ä
10,4 (â Åñòîí³¿) äî 0,2 (â ²ðëàí䳿, Ìàëüò³ òà Âåëèê³é
Áðèòàí³¿).
²íòåðåñ äî ñïåö³àëüíîñò³ çðîñòຠíà ºâðîïåéñü-
êîìó ð³âí³ – â³äñîòîê ðåçèäåíò³â â³ä ê³ëüêîñò³
ë³êàð³â ÔÐÌ êîëèâàºòüñÿ â³ä 36% ó Âåëèêîáðèòàí³¿
äî 2% ó Ðîñ³¿. Öå, çàçâè÷àé, çàëåæèòü â³ä ïðåñòè-
æó òà ïîçèö³¿ ñïåö³àëüíîñò³ ñåðåä ³íøèõ ìåäè÷íèõ
ñïåö³àëüíîñòåé òà ïîòðåá ðåàá³ë³òàö³¿ íàñåëåííÿ.
²íø³ êðà¿íè ç á³ëüøîþ ê³ëüê³ñòþ ðåçèäåíò³â, ïî-
ð³âíÿíî ç ïðàêòèêóþ÷èìè ë³êàðÿìè ÔÐÌ – Ñëîâå-
í³ÿ 32%, Íîðâåã³ÿ 19%, ͳäåðëàíäè 22%, Òóðå÷-
÷èíà 22% (Òàáëèöÿ ²).
Ó ªâðîï³ ³ñíóþòü íàö³îíàëüí³ òîâàðèñòâà ç äóæå
äàâí³ìè òðàäèö³ÿìè, çàñíîâàíèìè â 1920-õ ðîêàõ,
òàêèìè ÿê Romanian Society of Rehabilitation
Medicine. ²íø³ òîâàðèñòâà ç äîâãîþ ³ñòîð³ºþ -
Turkish League against Rheumatism (ç 1947),
Croatian Society of Physical and Rehabilitation
Medicine (ç 1947), Austrian Society of Physical
Medicine and Rehabilitation (ç 1950), Spanish Society
of Physical and Rehabilitation Medicine (ç 1954).
²ñíóþòü òàêîæ ìîëîä³ ñóñï³ëüñòâà, ïîä³áí³ äî
Óêðà¿íè òà Ìàëüòè, çàñíîâàí³ â 2014 ðîö³. ßê äàâ-
íÿ ñïåö³àëüí³ñòü ó âñ³õ ºâðîïåéñüêèõ êðà¿íàõ ë³êàð³
87
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Òàáëèöÿ ². Åï³äåì³îëîã³ÿ ñïåö³àëüíîñò³ Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà â ªâðîï³. ÔÐÌ: Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäè-
öèíà. Ïîêàçíèêè ê³ëüêîñò³ ë³êàð³â òà ñïåö³àë³ñò³â îòðèìàí³ â Eurostat (îíëàéí êîäè äàíèõ: hlth_rs_prs1 òà hlth_rs_spec).
*Çàãàëüíà ê³ëüê³ñòü òà çàãàëüí³ â³äñîòêè âèðàõîâàí³ ò³ëüêè äëÿ äîñòóïíèõ äàíèõ.

% ɥɿɤɚɪɿɜ
ɇɚɫɟɥɟɧɧɹ Ʌɿɤɚɪɿ ɋɩɟɰɿɚɥɿɫɬɢ ɉɪɚɤɬɢɤɭɸɱɢ ɥɿɤɚɪɿ ɎɊɆ Ɋɟɡɢɞɟɧɬɢ ɡ ɎɊɆ
ɎɊɆ
% ɫɟɪɟɞ % % ɫɟɪɟɞ
ɬɢɫɹɱ % ɫɟɪɟɞ ɧɚ 100 000
N N N ɫɩɟɰɿɚɥɿ ɫɟɪɟɞ N ɥɿɤɚɪɿɜ
ɦɟɲɤɚɧɰɿɜ ɥɿɤɚɪɿɜ ɦɟɲɤɚɧɰɿɜ
ɫɬɿɜ ɥɿɤɚɪɿɜ ɎɊɆ
Ⱥɜɫɬɪɿɹ 8474 44002 22204 50% 343 1,5% 0,8% 4,05
Ȼɟɥɶɝɿɹ 11200 34020 19399 57% 550 2,8% 1,6% 68 12 4,91
Ȼɨɥɝɚɪɿɹ 7090 29038 23191 80% 450 1,9% 1,5% 29 6 6,35
ɏɨɪɜɚɬɿɹ 4253 13430 9355 70% 397 4,2% 3,0% 53 13 9,33
Ʉɿɩɪ 1141 3032 2056 68% 9 0,4% 0,3% 0,79
ɑɟɫɶɤɚ 10520 38776 38499 99% 816 2,1% 2,1% 100 12 7,76
Ɋɟɫɩɭɛɥɿɤɚ
Ⱦɚɧɿɹ 5614 20639 9092 44%
ȿɫɬɨɧɿɹ 1325 4052 3297 81% 137 4,2% 3,4% 10,34
Ɏɿɧɥɹɧɞɿɹ 5439 17511 9953 57% 240 2,4% 1,4% 4,41
Ɏɪɚɧɰɿɹ 66030 207789 112100 54% 1927 1,7% 0,9% 340 18 2,92
Ɇɚɤɟɞɨɧɿɹ 2107 5975 3612 60% 130 3,6% 2,2% 16 12 6,17
Ƚɪɭɡɿɹ 10100 20000 10000 50% 400 4,0% 2,0% 15 4 3,96
ɇɿɦɟɱɱɢɧɚ 80620 338129 188476 56% 1800 1,0% 0,5% 150 8 2,23
Ƚɪɟɰɿɹ 11030 68401 47531 69% 210 0,4% 0,3% 35 17 1,90
ɍɝɨɪɳɢɧɚ 9897 30486 25000 82% 350 1,4% 1,1% 30 9 3,54
ȱɪɥɚɧɞɿɹ 4595 13446 5590 42% 11 0,2% 0,1% 2 18 0,24
ȱɡɪɚʀɥɶ 7940 27000 150 0,6% 40 27 1,89
ȱɬɚɥɿɹ 59801 233102 162281 70% 3500 2,2% 1,5% 490 14 5,85
Ʌɚɬɜɿɹ 2013 6324 4699 74% 130 2,8% 2,1% 20 15 6,46
Ʌɢɬɜɚ 2956 12605 9026 72% 398 4,4% 3,2% 38 10 13,46
Ʌɸɤɫɟɦɛɭɪɝ 536 1656 1067 64% 16 1,5% 1,0% 1 6 2,99
Ɇɚɥɶɬɚ 432 1636 817 50% 1 0,1% 0,1% 0,23
Ɇɨɧɬɟɧɟɝɪɨ 631 1466 1045 71% 55 5,3% 3,8% 2 4 8,72
ɇɿɞɟɪɥɚɧɞɢ 16800 58858 30918 53% 550 1,8% 0,9% 120 22 3,27
ɇɨɪɜɟɝɿɹ 5282 22848 8683 38% 261 3,0% 1,1% 50 19 4,94
ɉɨɥɶɳɚ 38530 88437 68609 78% 2047 3,0% 2,3% 160 8 5,31
ɉɨɪɬɭɝɚɥɿɹ 10296 47792 22323 47% 550 2,5% 1,2% 100 18 5,34
Ɋɭɦɭɧɿɹ 19322 54807 36971 67% 800 2,2% 1,5% 4,14
Ɋɨɫɿɹ 143436 1730 380 22 1,21
ɋɟɪɛɿɹ 8806 21840 13658 63% 693 5,1% 3,2% 34 5 7,87
ɋɥɨɜɚɱɱɢɧɚ 5431 18719 22100 118% 537 2,4% 2,9% 90 17 9,89
ɋɥɨɜɟɧɿɹ 2072 5830 3685 63% 78 2,1% 1,3% 25 32 3,76
ȱɫɩɚɧɿɹ 46054 178600 103325 58% 2000 1,9% 1,1% 350 18 4,34
ɒɜɟɰɿɹ 9876 40637 20573 51% 260 1,3% 0,6% 40 15 2,63
ɒɜɟɣɰɚɪɿɹ 8420 36762 18621 54% 227 1,2% 0,7% 35 15 2,70
Ɍɭɪɟɱɱɢɧɚ 79791 141259 6956 5% 2300 33,1% 1,6% 505 22 2,88
ɍɤɪɚʀɧɚ 44500 160912 89560 56% 0 0,0 0,0 0 0 0,00
ȼɟɥɢɤɚ 65180 181673 121211 67% 159 0,1% 0,1% 58 36 0,24
Ȼɪɢɬɚɧɿɹ
ɊȺɁɈɆ* 817540 2229489 1275483 58% 24212 1,8% 1,0% 3376 15 2,96

ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè ñòâîðèëè ñâî¿
ïðîôåñ³éí³ òà íàóêîâ³ îðãàí³çàö³¿ (Òàáëèöÿ ²²).
Ãîëîâíîþ ìåòîþ íàö³îíàëüíèõ òîâàðèñòâ ÔÐÌ
º ñïðèÿííÿ ðîçâèòêó Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè òà çàáåçïå÷åííÿ äîáðî¿ ðåàá³ë³òàö³éíî¿
äîïîìîãè îñîáàì, ÿê³ çàçíàþòü àáî ìîæóòü çàç-
íàòè îáìåæåíü æèòòºä³ÿëüíîñò³, ïðîïàãóâàííÿ
ñïåö³àëüíîñò³ ÔÐÌ òà ïðîôåñ³¿ ÔÐÌ, à òàêîæ ðîç-
âèòîê ðåàá³ë³òàö³éíèõ ñëóæá. ̳ñ³ÿ òà ä³ÿëüí³ñòü
òîâàðèñòâ âêëþ÷àþòü ïðîïàãàíäó ðîçâèòêó íàóêî-
âèõ çíàíü ùîäî ðåàá³ë³òàö³¿, ñõâàëåííÿ íàóêîâèõ
äîñë³äæåíü, ïðîñóâàííÿ îñâ³òè â ðåàá³ë³òàö³¿ òà
ïîïóëÿðèçàö³ÿ ³äå¿ êîìïëåêñíî¿ ðåàá³ë³òàö³¿ íà êî-
ðèñòü òèõ, õòî öüîãî ïîòðåáóº, ï³äâèùóþ÷è êâàë³-
ô³êàö³þ ÷ëåí³â.
Äåÿê³ òîâàðèñòâà ìàþòü ïåðåâàæíî íàóêîâ³ òà
îñâ³òí³ ö³ë³, ïîâ’ÿçàí³ ç ïðîôåñ³éíèì ðîçâèòêîì
ñïåö³àë³ñò³â, à ³íø³ çàéìàþòüñÿ çàõèñòîì ïðîôåñ³é-
íèõ ³íòåðåñ³â ë³êàð³â ÔÐÌ, âèçíà÷àþòü êîìïåòåí-
òíîñò³ ë³êàð³â ÔÐÌ, ¿õ ñòîñóíêè ç ³íøèìè ÷ëåíàìè
êîìàíäè, ç ³íøèìè ìåäè÷íèìè ë³êàðÿìè òà ³íøè-
ìè ôàõ³âöÿìè îõîðîíè çäîðîâ’ÿ. Âîíè çîñåðåäæó-
þòüñÿ íà ñòâîðåíí³ êë³í³÷íèõ íàñòàíîâ, êë³í³÷íèõ
ñòàíäàðò³â íàëåæíî¿ ïðàêòèêè òà ñïðèÿþòü ñïåö³-

88 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 5 – ÎÐÃÀͲÇÀÖ²¯ ÔÐÌ Â ªÂÐÎϲ: ÑÒÐÓÊÒÓÐÀ ÒÀ IJßËÜͲÑÒÜ

Òàáëèöÿ ²². Íàçâè íàö³îíàëüíèõ íàóêîâèõ òà ïðîôåñ³éíèõ òîâàðèñòâ Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³ òà ¿õ îô³ö³éí³
æóðíàëè.

ɇɚɡɜɚ ɧɚɭɤɨɜɨɝɨ ɇɚɡɜɚ

ɬɨɜɚɪɢɫɬɜɚ ɧɚ ɥɨɤɚɥɶɧɿɣ Ɋɿɤ ɩɪɨɮɟɫɿɣɧɨɝɨ
Ʉɪɚʀɧɚ ɇɚɰɿɨɧɚɥɶɧɟ ɬɨɜɚɪɢɫɬɜɨ ɡɚɫɧɭɜɚɧɧɹ ɀɭɪɧɚɥ
ɦɨɜɿ ɬɨɜɚɪɢɫɬɜɚ
Ⱥɜɫɬɪɿɹ Austrian Society of Physical Österreichische Gesellschaft für 1950 NA
Medicine and Rehabilitation Physikalische Medisin und
Rehabilitation
Ȼɟɥɶɝɿɹ Belgian Society of Physical Société Royale Belge de 1910 VBS FGR/GBS
Medicine and Rehabilitation Médecine physique et MPR
Réadaptation Koninklijke
Belgische Vereniging Voor
Fysische Geneeskunde &
Revalidatie
Ȼɨɫɧɿɹ ɬɚ Association of Physiatrists of Udruženje Fizijatara Republike 2000 NA
Ƚɟɪɰɟɝɨɜɢɧɚ Republic of Srpska Srpske
Ȼɨɥɝɚɪɿɹ Association of Physical Ⱥɫɨɰɢɚɰɢɹ ɩɨ Ɏɢɡɢɤɚɥɧɚ 1964 NA Fisikalna Medisina.
Medicine and Rehabilitation ɦɟɞɢɰɢɧɚ ɢ ɪɟɯɚɛɢɥɢɬɚɰɢɹ Rehabilitasia. Sdrave
ɏɨɪɜɚɬɿɹ Croatian Society of Physical Hrvatsko društvo za fizikalnu i 1947 Fizikalna i
and Rehabilitation Medicine rehabilitacijsku medicinu, rehabilitacijska
Hrvatski lijeþniþki zbor medicina
Ʉɿɩɪ Cyprus Society of Physical ȀȣʌȡȚĮțȒ ǼIJĮȚȡİȓĮ ĭȣıȚțȒȢ 1987 NA
Medicine and Rehabilitation ǿĮIJȡȚțȒȢ țĮȚ ǹʌȠțĮIJȐıIJĮıȘȢ.
ɑɟɫɶɤɚ Society of Rehabilitation and Spoleþnost Rehabilitaþní A 1967 Rehabilitace a
Ɋɟɫɩɭɛɥɿɤɚ Physical Medicine of Czech Fysikální Medicíny (SRFM) Fysikalni Lekarstvi
Medical Association of J.E.
Purkyne
Ⱦɚɧɿɹ
ȿɫɬɨɧɿɹ Estonian Society of Physical Eesti Taastusarstide Selts 1992
and Rehabilitation Medicine
Doctors
Ɏɿɧɥɹɧɞɿɹ Finnish Society of Physical and Societas Medicinae Physicalis 1956
Rehabilitation Medicine et Rehabilitationis Fenniae ry
Ɏɪɚɧɰɿɹ French society of Physical and Société Française de Médecine 1974 French Union of Annals of Physical
Rehabilitation Medicine Physique et de Réadaptation Physical and and Rehabilitation
SOFMER Rehabilitation Medicine
Medicine - Syndicat
français de MPR
(SYFMER)
Ɇɚɤɟɞɨɧɿɹ Association of doctors for Sdrusenie na doktori po 1955
physical medicine and fisikalna medicina I
rehabilitation rehabilitacija
Ƚɪɭɡɿɹ Georgian Physical Therapy ʹʨʽʨʸʯʭʬʲʵʹ 2003 Georgian Physical
association ʼʰʮʰʵʯʬʸʨʶʬʭʺʯʨ Medicine
ʨʹʵ˂ʰʨ˂ʰʨ Association
ɇɿɦɟɱɱɢɧɚ German Society for Physical Deutche Gesellschaft fur Professional Physikalishe Medisine
Medicine and Rehabilitation - Physikalische Medisin und Association of Rehabilitationmedesin
Scientific Society for Physical Rehabilitation Physical and Kurortmedisin
Medicine and Rehabilitation, Rehabilitation Journal of Physical
Balneology and Medical Medicine (BVPRM) and Rehabilitation
Climatology (DGPMR) - Berufsverband der Medicine
Rehabilitationsartse
Ƚɪɟɰɿɹ Hellenic Society of Physical ǼȜȜȘȞȚțȒ ǼIJĮȚȡİȓĮ ĭȣıȚțȒȢ 1974 NA European Journal of
and Rehabilitation Medicine ǿĮIJȡȚțȒȢ țĮȚ ǹʌȠțĮIJȐıIJĮıȘȢ Physical and
(HSPRM) (ǼǼĭǿǹʌ) Rehabilitation
Medicine
ɍɝɨɪɳɢɧɚ Hungarian Rehabilitation Magyar Rehabilitációs Társaság 1966 Rehabilitáció
Society
ȱɪɥɚɧɞɿɹ Irish Association of Irish Association of 1989
Rehabilitation Medicine Rehabilitation Medicine
ȱɡɪɚʀɥɶ Physical Medicine and ʤʠʥʴʸ ʺʩʬʷʩʦʩʴ ʭʥʷʩʹʥ 1948
Rehabilitation
ȱɬɚɥɿɹ Italian Society of Physical and SIMFER Società Italiana di 1958 Italian Union of European Journal of
Rehabilitation Medicine Medicina Fisica e Riabilitazione Physical and Physical and
Rehabilitation Rehabilitation
Medicine physicians Medicine
- Sindacato italiano
Medici Medicina
Fisica e Riabilitativa
- SIMMFiR
Ʌɚɬɜɿɹ Latvian Society of The Latvijas FizikƗlƗs Un 1998 the Association of
Physical and Rehabilitation RehabilitƗcijas MedicƯnas Ɩrstu Latvian
Medicine Doctors BiedrƯba Rehabilitation
physicians - Latvijas
Ɨrstu Rehabilitologu
asociƗcija
Ʌɢɬɜɚ
Ʌɸɤɫɟɦɛɭɪɝ Luxemburgish Society of Société luxembourgeoise de 1993
Physical and Rehabilitation médecine physique et de
Medicine réadaptation

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 89
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Òàáëèöÿ ²². Íàçâè íàö³îíàëüíèõ íàóêîâèõ òà ïðîôåñ³éíèõ òîâàðèñòâ Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³ òà ¿õ îô³ö³éí³
æóðíàëè (ïðîäîâæåííÿ).

ɇɚɡɜɚ ɧɚɭɤɨɜɨɝɨ ɇɚɡɜɚ

Ɋɿɤ
Ʉɪɚʀɧɚ ɇɚɰɿɨɧɚɥɶɧɟ ɬɨɜɚɪɢɫɬɜɨ ɬɨɜɚɪɢɫɬɜɚ ɧɚ ɥɨɤɚɥɶɧɿɣ ɩɪɨɮɟɫɿɣɧɨɝɨ ɀɭɪɧɚɥ
ɡɚɫɧɭɜɚɧɧɹ
ɦɨɜɿ ɬɨɜɚɪɢɫɬɜɚ
Ɇɚɥɶɬɚ Malta Physical & Malta Physical & Rehabilitation 2013
Rehabilitation Medicine Medicine Association
Association
Ɇɨɧɬɟɧɟɝɪɨ
ɇɿɞɟɪɥɚɧɞɢ Netherlands Society of Vereniging van 1955 Nederlands Tijdschrift
Rehabilitation Medicine Revalidatieartsen Revalidatiegeneeskun
de (NTR).
ɇɨɪɜɟɝɿɹ The Norwegian Society of Norsk Forening for Fysikalsk 1977 The Norwegian
Physical Medicine and medisin og Rehabilitering. Association of
Rehabilitation NFFR. Physical and
Rehabilitation
medicine - Norsk
Forening for Fysikalsk
medisin og
Rehabilitering (NFFR)
ɉɨɥɶɳɚ Polish Rehabilitation Society Polskie Towarzystwo 1989 PostĊpy Rehabilitacji
Rehabilitacji (eng. Advances in
Rehabilitation)
ɉɨɪɬɭɝɚɥɿɹ Portuguese Society of Physical Sociedade Portuguesa de 1953 Revista da Sociedade
and Rehabilitation Medicine Medicina Física e de Portuguesa MFR
Reabilitação
Ɋɭɦɭɧɿɹ Romanian Society of Societatea Romana de 1922 Romanian Journal of
Rehabilitation Medicine Reabilitare Medicala Rehabilitation
Medicine
Ɋɨɫɿɹ All-Russian Union ɋɨɸɡ ɪɟɚɛɢɥɢɬɨɥɨɝɨɜ Ɋɨɫɫɢɢ 2013 "Herald of
Rehabilitators (ARUR ) (ɋɊɊ) Regenerative
medicine"
Ɋɟɫɩɭғɛɥɿɤɚ Serbian Association of Physical Udruženja za fizikalnu i 1952 Balneoclimatology
ɋɟғɪɛɿɹ and Rehabilitation Medicine rehabilitacionu medicinu Srbije
ɋɥɨɜɚɱɱɢɧɚ Slovak Society of Physical and Slovenská spoloþnosĢ fysiatrie. 1975 Rehabilitácia
Rehabilitation Medicine balneológie a lieþebnej
rehabilitácie
ɋɥɨɜɟɧɿɹ Slovenian Society for Physical Slovensko Sdruženje sa 1998 Rehabilitacija
and Rehabilitation Medicine fisikalno in rehabilitacijsko
medicino
ȱɫɩɚɧɿɹ Spanish Society of Physical Sociedad Española de 1954 Rehabilitación
and Rehabilitation Medicine Rehabilitación y Medicina
Física
ɒɜɟɰɿɹ Swedish Society of Svenst Forening for 1969 Journal of
Rehabilitation Medicine Rehabilitering medicin Rehabilitation
Medicine
ɒɜɟɣɰɚɪɿɹ Swiss Society of Physical and German: Schweizerische 1930
Rehabilitation Medicine Gesellschaft für Physikalische
Medizin und Rehabilitation
French: Société Suisse de
Médecine physique et de
Réadaptation
Italien : Società Svizzera di
Medicina fisica e Riabilitazione
Ɍɭɪɟɱɱɢɧɚ 1. Turkish League Against 1.Türkiye Romatizma 1947 Archives of
Rheumatism AraútÕrma ve Savaú Derne÷i Rheumatology

2. Turkish Society of Physical 2. Türkiye Fiziksel TÕp ve 1958 Turkish Journal of

Medicine and Rehabilitation Rehabilitasyon Derne÷i Physical Medicine
and Rehabilitation
3.Turkish Society of 3.Türk.TÕbbi Rehabilitasyon 1978
Rehabilitation Medicine Kurumu Derne÷i
4. Turkish Society of Physical 4. Türkiye Fiziksel TÕp ve 1996 Journal of Physical
Medicine and Rehabilitation Rehabilitasyon Uzman Medicine
Specialists Hekimleri Derne÷i and Rehabilitation
Sciences
ɍɤɪɚʀɧɚ Ukrainian Society of Physical Ƚɪɨɦɚɞɫɶɤɚ ɨɪɝɚɧɿɡɚɰɿɹ 2014 ɍɤɪɚʀɧɫɶɤɢɣ ɠɭɪɧɚɥ
and Rehabilitation Medicine "ɍɤɪɚʀɧɫɶɤɟ ɬɨɜɚɪɢɫɬɜɨ ɮɿɡɢɱɧɨʀ ɬɚ
ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ
ɦɟɞɢɰɢɧɢ" ɦɟɞɢɰɢɧɢ
ȼɟɥɢɤɚ British Society of British Society of Rehabilitation 1984 Clinical
Ȼɪɢɬɚɧɿɹ Rehabilitation Medicine Medicine Rehabilitation

90 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018

àëüíîñò³ äëÿ ïðîâåäåííÿ íåîáõ³äíèõ äîñë³äæåíü
äëÿ ¿¿ ïîäàëüøîãî ðîçâèòêó. ª òîâàðèñòâà, ÿê³
îõîïëþþòü óñ³ ö³ ïîëÿ. Íàö³îíàëüí³ òîâàðèñòâà
ÔÐÌ îðãàí³çîâóþòü ðåãóëÿðí³ íàóêîâ³ çàõîäè íà
ÔÐÌ-êîíôåðåíö³ÿõ òà êîíãðåñàõ ³ â³äïîâ³äàþòü çà
áåçïåðåðâíó ìåäè÷íó îñâ³òó.
Ñèëà òîâàðèñòâ ïîëÿãຠâ òîìó, ùî âîíè âêëþ-
÷àþòü â ñåáå âñå á³ëüøó ê³ëüê³ñòü ë³êàð³â ÔÐÌ,
ÿê³ ïðèñâÿòèëè ñåáå ðîçâèòêó ÔÐÌ, äëÿ ï³äâèùåí-
íÿ íàóêîâîãî ð³âíÿ òà ä³ÿëüíîñò³, äóæå äîáðå
îðãàí³çîâàíèõ êîíãðåñ³â òà áåçïåðåðâíî¿ ìåäè÷íî¿
îñâ³òè, ãàðíîãî ñï³âðîá³òíèöòâà ç ³íøèìè íàö³î-
íàëüíèìè òà ì³æíàðîäíèìè òîâàðèñòâàìè, óñòàíî-
âàìè òà îðãàí³çàö³ÿìè, ùî çàëó÷åí³ äî ðåàá³ë³òàö³¿.
Ñëàáê³ñòü çàçâè÷àé âêëþ÷ຠíèçüêèé àáî âàæ-
êèé çâ’ÿçîê ç óðÿäîì òà ô³íàíñîâèìè ³íñòèòóö³ÿ-
ìè, íåäîñòàòíüîþ àêòèâí³ñòþ òà ñèëîþ ó çàõèñò³
ïðîôåñ³éíèõ ³íòåðåñ³â ë³êàð³â ÔÐÌ òà, â äåÿêèõ
êðà¿íàõ – íèçüêèé ð³âåíü êîìóí³êàö³¿ ç ³íøèìè
ñïåö³àë³ñòàìè, òà íåïîñò³éíó ê³ëüê³ñòü àêòèâíèõ
÷ëåí³â.
Á³ëüø³ñòü íàö³îíàëüíèõ òîâàðèñòâ âèïóñêàþòü
âëàñíèé íàóêîâèé æóðíàë. ²íø³, òàê³ ÿê ³ Ãðåöüêå
òîâàðèñòâî, âèêîðèñòîâóþòü European Journal of
Physical and Rehabilitation Medicine, ÿê íàö³îíàëü-
íèé æóðíàë. Äåÿê³ ç íàö³îíàëüíèõ æóðíàë³â áåðóòü
ó÷àñòü ó ªâðîïåéñüê³é ìåðåæ³ æóðíàë³â ÔÐÌ, ÿêà
áóëà çàñíîâàíà ó 2010 ðîö³ ç îñíîâíèìè ö³ëÿìè
ñòâîðåííÿ ìàêñèìàëüíî øèðîêî¿ àóäèòî𳿠äðóêî-
âàíèõ ïðàöü, îïóáë³êîâàíèõ ó ºâðîïåéñüêèõ æóðíà-
ëàõ (Òàáëèöÿ ²²).
Íàóêîâ³ çàõîäè ÔÐÌ òà ¿õ ïðåäñòàâíèöòâî
â ªâðîï³ – ìóëüòèíàö³îíàëüíà ÔÐÌ
ªâðîïè
Íàóêîâ³ æóðíàëè º êëþ÷îâèìè ãðàâöÿìè ÔÐÌ
â ªâðîï³, îñê³ëüêè âîíè ñëóãóþòü ðîçâèòêó íàóêè
òà äîñë³äæåíü ó íàø³é ãàëóç³. Î÷åâèäíî, ùî æóð-
íàëè â³ä³ãðàþòü ì³æíàðîäíó ðîëü ó òîìó, ùî âîíè
ïóáë³êóþòü, àëå â ÔÐÌ ³ñíóº ùîíàéìåíøå äâà
îñíîâíèõ ÷èííèêè, ÿê³ âèçíà÷àþòü ì³ñöåçíàõîä-
æåííÿ æóðíàëó. Íàñïðàâä³, Ô³çè÷íà òà Ðåàá³ë³òà-
ö³éíà Ìåäèöèíà º “íàóêîâî” ìîëîäîþ23, ³ òðàäèö³¿
ïðîäîâæóþòü â³ä³ãðàâàòè ïåâíó ðîëü ó âòðó÷àííÿõ,
äîêàçîâ³ñòü ÿêèõ íå º âèñîêîþ, àëå ÿê³, íåçâàæàþ-
÷è íà öå, ïðîïîíóþòüñÿ â ïåâíèõ ãåîãðàô³÷íèõ ðàé-
îíàõ (íàïð. äåÿê³ ìîäàëüíîñò³, áàëüíåîëîã³ÿ, ñïà-
òåðàï³ÿ òîùî). Á³ëüøå òîãî, ó ÔÐÌ êîíòåêñòóàëüí³
ôàêòîðè â³ä³ãðàþòü âàæëèâó ðîëü ó âèçíà÷åíí³
ì³ñöåâèõ òåðàïåâòè÷íèõ ïðîïîçèö³é24,25: ó òîé ÷àñ,
ÿê ªâðîïà â ö³ëîìó â³äð³çíÿºòüñÿ â³ä ³íøèõ êîíòè-
íåíò³â, âñå ùå ³ñíóþòü â³äì³ííîñò³ ì³æ ï³âí³÷÷þ òà
ï³âäíåì, à òàêîæ çàõ³äíîþ òà ñõ³äíîþ ªâðîïîþ. Âñå
öå ìîæå ìàòè âïëèâ íà ºâðîïåéñüê³ æóðíàëè.
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 5 – ÎÐÃÀͲÇÀÖ²¯ ÔÐÌ Â ªÂÐÎϲ: ÑÒÐÓÊÒÓÐÀ ÒÀ IJßËÜͲÑÒÜ
ªÒÔÐÌ ê³ëüêà ðîê³â òîìó âèð³øèâ âèçíà÷èòè
«Îñíîâí³ æóðíàëè ÔÐÌ» â³äïîâ³äíî äî ñïåöèô³÷-
íèõ òà ñóâîðèõ êðèòåð³¿â26,27: ó 2008 ðîö³ áóâ ñòâî-
ðåíèé ïåðøèé áëîê ç 3 ºâðîïåéñüêèõ æóðíàë³â
(Journal of Rehabilitation Medicine, Clinical
Rehabilitation, Disability and Rehabilitation) òà áóëè
äîäàí³ òàêîæ 2 àìåðèêàíñüê³ æóðíàëè. Çà ê³ëüêà
ðîê³â, ó 2013 ðîö³, öåé ñïèñîê ðîçøèðèâñÿ, âêëþ-
÷èâøè ùå 2 ºâðîïåéñüêèõ æóðíàëè (European
Journal of Physical and Rehabilitation Medicine òà
International Journal of Rehabilitation Research).
Ïðîòÿãîì öèõ ðîê³â òàêîæ ñòâîðåíî ªâðîïåéñüêó
ìåðåæó íàö³îíàëüíèõ æóðíàë³â, àëå âîíà áóëà íå
ïîâí³ñòþ ðîçâèíåíîþ28,29.
Âñ³ ªâðîïåéñüê³ Îðãàíè ìàþòü ñâî¿ îô³ö³éí³
æóðíàëè, ³ ìè ñïî÷àòêó ðîçãëÿíåìî ¿õ: ïîò³ì ìè
ïðåäñòàâèìî ³íø³ ìóëüòèíàö³îíàëüí³ æóðíàëè, òîá-
òî ò³, ÿê³ ìàþòü ³íòåðåñ ó á³ëüø í³æ îäí³é êðà¿í³.
Ñòàí íàéá³ëüø âàæëèâèõ ³íäåêñ³â ºâðîïåéñüêèõ
æóðíàë³â çà îñòàíí³ ðîêè íàâåäåíèé â Òàáëèö³ ²²².
¯õ îñíîâí³ ïîêàçíèêè íàâåäåí³ â Òàáëèö³ IV òà
îñíîâíèé çì³ñò – â Òàáëèö³ V. Ïðåäñòàâíèöòâî
êðà¿í – â Òàáëèö³ VI.
Annals of Physical and Rehabilitation Medicine
(APRM) – îô³ö³éíèé æóðíàë Ñåêö³¿ ÔÐÌ
ªÑÌÑ
Æóðíàë ³íäåêñóºòüñÿ â MEDLINE, Web of
Science òà SCImago.
Êàòåãî𳿠ðîá³ò âêëþ÷àþòü: îðèã³íàëüí³ êë³í³÷í³,
åï³äåì³îëîã³÷í³ òà äîñë³äíèöüê³ ñòàòò³, îãëÿäîâ³
ñòàòò³, ðåäàêö³éí³ ñòàòò³ òà íàñòàíîâè. Íà ðîçñóä
ãîëîâíîãî ðåäàêòîðà, 20-30% îïóáë³êîâàíèõ ðîá³ò
íåãàéíî íàäàºòüñÿ â³ëüíèé äîñòóï. Âñ³ ïóáë³êàö³¿
ïîòðàïëÿþòü äî â³ëüíîãî äîñòóïó çà îäèí ð³ê. Ïóá-
ë³êàö³¿ â Annals of Physical and Rehabilitation
Medicine º áåçêîøòîâíèìè.
European Journal of Physical and
Rehabilitation Medicine (EJPRM) – îô³ö³éíèé
æóðíàë ªÒÔÐÌ òà Ñåêö³¿ òà Ðàäè ÔÐÌ
ªÑÌÑ
Æóðíàë ³íäåêñóºòüñÿ â CINAHL, Current
Content / Clinical Medicine, EMBASE, PubMed /
MEDLINE, Index Cited Index Expanded (SciSearch),
Scopus.
Êàòåãî𳿠ðîá³ò âêëþ÷àþòü: îðèã³íàëüí³ ñòàòò³,
ñèñòåìàòè÷í³ îãëÿäè òà ìåòà-àíàë³çè, íàñòàíîâè,
ñïåö³àëüí³ ñòàòò³, êë³í³÷í³ âèïàäêè òà ëèñòè. 3 ÷åðâ-
íÿ 2007 ðîêó â³í ðåãóëÿðíî ïóáë³êóº Êîêðàí³âñüê³
îáçîðè òà Cochrane Corner. EJPRM âèìàãàº, ùîá
àâòîðè äîòðèìóâàëèñÿ íàñòàíîâ ùîäî ïóáë³êàö³é
(www.equator-network.org).
Îáëàñò³ ³íòåðåñ³â: êë³í³÷í³ ñòàòò³ ó âñ³õ ñóáñïå-
ö³àëüíîñòÿõ ÔÐÌ (íåâðîëîã³÷í³, ì’ÿçîâî-ñêåëåòí³,
91
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Òàáëèöÿ ²²²À. Äâà ãîëîâíèõ á³áë³îìåòðè÷íèõ ³íäåêñè æóðíàë³â ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè ç ì³æíàðîäíèì ïîøèðåííÿì
â Journal Citation Report (êàòåãîð³ÿ «rehabilitation», 2012-2016)

ȱɦɩɚɤɬ-ɮɚɤɬɨɪ ɡɚ 2 ɪɨɤɢ ȱɦɩɚɤɬ-ɮɚɤɬɨɪ ɛɟɡ ɫɚɦɨɰɢɬɭɜɚɧɧɹ

(ɩɨɡɢɰɿɹ ɫɟɪɟɞ 65) (ɩɨɡɢɰɿɹ ɫɟɪɟɞ 65)
2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Ann Phys Rehabil - - - - - - - - - -
Med
Eur J Phys Rehabil 2.06 (15) 1.95 (14) 1.90 (17) 2.06 (12) 1.83 (20) 1.69 (14) 1.50 (21) 1.47 (23) 1.77 (13) 1.76 (17)
Med
J Rehabil Med 2.13 (14) 1.89 (16) 1.68 (23) 1.59 (25) 1.68 (27) 1.88 (11) 1.72 (14) 1.52 (20) 1.46 (26) 1.53 (28)
Clin Rehabil 2.19 (13) 2.18 (11) 2.249 (10) 2.40 (10) 2.82 (9) 2.09 (9) 2.02 (11) 2.06 (10) 2.25 (8) 2.61 (8)
Int J Rehabil 1.05 (43) 1.14 (39) 1.28 (37) 1.25 (40) 1.26 (38) 0.98 (37) 0.94 (41) 1.14 (35) 1.11 (36) 1.1 (41)
Research
Phys Med Rehab 0.26 (59) 0.45 (59) 0.33 (62) 0.25 (64) 0.26 (63) 0.11 (61) 0.28 (59) 0.27 (61) 0.14 (64) 0.19 (63)
Kuror
Rehabilitación - - - - - - - - - -
(Madr.)

Òàáëèöÿ ²²²Á. Äâà ãîëîâíèõ á³áë³îìåòðè÷íèõ ³íäåêñè æóðíàë³â ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè ç ì³æíàðîäíèì ïîøèðåííÿì
â Scimago Data Base (êàòåãîð³ÿ «rehabilitation», 2012-2016)

ɐɢɬɭɜɚɧɶ ɧɚ ɞɨɤɭɦɟɧɬ - 2 ɪɨɤɢ Ɋɟɣɬɢɧɝ ɠɭɪɧɚɥɭ ɭ Scopus SCImago

(ɩɨɡɢɰɿɹ ɫɟɪɟɞ 119) (ɩɨɡɢɰɿɹ ɫɟɪɟɞ 119)
2012 2013 2014 2015 2016 2012 2013 2014 2015 2016
Ann Phys Rehabil 1.41 (34) 1.40 (35) 1.50 (34) 1.80 (22) 1.69 (22) 0.59 (31) 0.54 (39) 0.47 (44) 0.51 (45) 0.58 (38)
Med
Eur J Phys Rehabil 2.23 (15) 2.24 (15) 2.20 (15) 2.23 (11) 1.70 (21) 0.72 (23) 0.73 (23) 0.82 (18) 0.78 (22) 0.81 (17)
Med
J Rehabil Med 2.73 (7) 2.32 (13) 1.99 (20) 1.84 (19) 1.81 (16) 1.20 (8) 1.03 (12) 1.07 (10) 0.91 (14) 0.90 (14)
Clin Rehabil 2.48 (9) 2.64 (9) 2.99 (8) 2.72 (9) 2.42 (9) 1.17 (10) 0.99 (15) 1.12 (7) 1.14 (9) 1.19 (8)
Int J Rehabil 1.23 (36) 1.37 (37) 1.42 (36) 1.44 (34) 1.37 (33) 0.513 (35) 0.50 (44) 0.61 (34) 0.57 (39) 0.62 (33)
Research
Phys Med Rehab 0.27 (78) 0.32 (72) 0.26 (87) 0.22 (88) 0.27 (83) 0.164 (83) 0.19 (79) 0.17 (85) 0.18 (84 0.19 (81)
Kuror
Rehabilitación 0.18 (88) 0.06 (104) 0.15 (96) 0.11 (99) 0.13 (95) 0.14 (91) 0.10 (113) 0.13 (98) 0.11 (102) 0.12 (99)
(Madr.)

Òàáëèöÿ IV. Îñíîâí³ ïîêàçíèêè æóðíàë³â ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè ç ì³æíàðîäíèì ïîøèðåííÿì

ɑɚɫ ɞɨ ɩɟɪɲɨʀ ɑɚɫ ɞɨ ɩɭɛɥɿɤɚɰɿʀ

Ɇɨɜɚ ȼɢɩɭɫɤɿɜ ɧɚ ɪɿɤ Ɋɿɜɟɧɶ ɜɿɞɦɨɜ
ɜɿɞɩɨɜɿɞɿ (ɞɧɿɜ) (ɦɿɫɹɰɿɜ)
Ann Phys Rehabil Med Ⱥɧɝɥɿɣɫɶɤɚ 6 75% 30 4
Eur J Phys Rehabil Med Ⱥɧɝɥɿɣɫɶɤɚ 6 73% 30 7
J Rehabil Med Ⱥɧɝɥɿɣɫɶɤɚ 10 65% 30 2
Clin Rehabil Ⱥɧɝɥɿɣɫɶɤɚ 12 86% 14 2
Int J Rehabil Research Ⱥɧɝɥɿɣɫɶɤɚ 4 70% 7 6
Phys Med Rehab Kuror ɇɿɦɟɰɶɤɚ ɬɚ Ⱥɧɝɥɿɣɫɶɤɚ 6
ȱɫɩɚɧɫɶɤɚ (Ⱥɧɝɥɿɣɫɶɤɚ ȿɥɟɤɬɪɨɧɧɚ: 10
Rehabilitación (Madr.) 4 56% 60
ɩɪɢɣɦɚɽɬɶɫɹ) Ⱦɪɭɤ: 11

Òàáëèöÿ V. Òåìàòè÷íèé çì³ñò ºâðîïåéñüêèõ æóðíàë³â â 2015ð.

Ɇ’ɹɡɨɜɨ- Ʉɚɪɞɿɨ - Ɂɚɝɚɥɶɧɚ

ɇɟɜɪɨɥɨɝɿɱɧɚ ȱɧɲɟ
ɫɤɟɥɟɬɧɚ ɩɭɥɶɦɨɧɚɪɧɚ ɪɟɚɛɿɥɿɬɚɰɿɹ
Ann Phys Rehabil Med 40% 25% 20% 10% 5%
Eur J Phys Rehabil Med 37% 35% 8% 11% 9%
J Rehabil Med 55% 23% 4% 20% 3%
Clin Rehabil 48% 28% 4% 6% 14%
Int J Rehabil Research 37% 25% 1% 25% 12%
Phys Med Rehab Kuror
Rehabilitación (Madr.) 34% 24% 12% 15% 15%

92 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 5 – ÎÐÃÀͲÇÀÖ²¯ ÔÐÌ Â ªÂÐÎϲ: ÑÒÐÓÊÒÓÐÀ ÒÀ IJßËÜͲÑÒÜ

Òàáëèöÿ VI. Ãåîãðàô³÷íå ïðåäñòàâíèöòâî ºâðîïåéñüêèõ æóðíàë³â

Ʉɪɚʀɧɢ (%)
ȯɜɪɨɩɚ
I II III IV V
Ann Phys Rehabil Med 65% Ɏɪɚɧɰɿɹ ɋɒȺ Ʉɚɧɚɞɚ Ȼɟɥɶɝɿɹ ɇɿɦɟɱɱɢɧɚ
Eur J Phys Rehabil Med 58% ȱɬɚɥɿɹ Ɍɭɪɟɱɱɢɧɚ ɇɿɦɟɱɱɢɧɚ Ȼɪɚɡɢɥɿɹ Ɏɪɚɧɰɿɹ
(35%) (6%) (6%) (5%) (5%)
J Rehabil Md 60% ɇɿɞɟɪɥɚɧɞɢ ɒɜɟɰɿɹ Ⱥɜɫɬɪɚɥɿɹ Ⱦɚɧɿɹ ɋɒȺ
(16%) (11%) (7%) (5%) (5%)
Clin Rehabil 49% ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ Ʉɢɬɚɣ ɇɿɞɟɪɥɚɧɞɢ Ⱥɜɫɬɪɚɥɿɹ Ʉɚɧɚɞɚ
(18%) (9%) (8%) (7%) (6%)
Int J Rehabil Research 64% ȱɬɚɥɿɹ ɋɒȺ ɇɿɞɟɪɥɚɧɞɢ ɒɜɟɰɿɹ Ⱥɜɫɬɪɚɥɿɹ
(15%) (7%) (6%) (6%) (5%)
Phys Med Rehab Kuror
Rehabilitación (Madr.) 81% ȱɫɩɚɧɿɹ Ʉɨɥɭɦɛɿɹ ɑɿɥɿ ɒɜɟɣɰɚɪɿɹ -
(78%) (11%) (4%) (4%)

êàðä³î-ïóëüìîíàðí³, ïåä³àòðè÷í³, çàãàëüíà ðåàá³ë³òà-
ö³ÿ òîùî). Ç 2006 ðîêó (âïåðøå ñåðåä æóðíàë³â ÔÐÌ
ó âñüîìó ñâ³òîâ³) íàäຠ÷èòà÷àì â³äêðèòèé áåçêîø-
òîâíèé îíëàéí äîñòóï äî ïîâíîòåêñòîâèõ ïóáë³êàö³é.
Journal of Rehabilitation Medicine (JRM) –
îô³ö³éíèé æóðíàë Ðàäè ÔÐÌ òà ªÀÐÌ
Æóðíàë ³íäåêñóºòüñÿ â MEDLINE, PubMed.
Êàòåãî𳿠ðîá³ò âêëþ÷àþòü: îðèã³íàëüí³ ñòàòò³, îã-
ëÿäè, êë³í³÷í³ âèïàäêè, êîðîòê³ ïîâ³äîìëåííÿ, êîðîòê³
äîïîâ³ä³ òà ëèñòè. Îáëàñò³ ³íòåðåñ³â: ôóíêö³îíàëü-
íå îö³íþâàííÿ òà ³íòåðâåíö³éí³ äîñë³äæåííÿ, êë³í³÷í³
äîñë³äæåííÿ ð³çíèõ ãðóï ïàö³ºíò³â, ìåòîäîëîã³ÿ
ÔÐÌ, åï³äåì³îëîã³÷í³ äîñë³äæåííÿ ç âèâ÷åííÿ îá-
ìåæåíü æèòòºä³ÿëüíîñò³ òà çâ³òè ïðî ïðîôåñ³éí³,
ñîö³àëüíî-ìåäè÷í³ àñïåêòè ðåàá³ë³òàö³¿. Ç 2017 ð.
Journal of Rehabilitation Medicine ñòàíå ïîâí³ñòþ
îíëàéí-æóðíàëîì ç íåãàéíèì â³äêðèòèì äîñòóïîì
ç ôàêòè÷íîãî â³äêðèòîãî äîñòóïó ï³ñëÿ 6 ì³ñÿö³â
Clinical Rehabilitation (CR)
Æóðíàë ³íäåêñîâàíèé (ñåðåä ³íøèõ) ÀѲÀ,
CINAHL, Current Contents / Clinical Medicine,
EMCare, MEDLINE, PsycINFO, Science Citation
Index, Scopus.
Êàòåãî𳿠ðîá³ò âêëþ÷àþòü: îðèã³íàëüí³ ñòàòò³,
ñèñòåìàòè÷í³ îãëÿäè, êîðåñïîíäåíòñüê³ ñòàòò³
“Ðåàá³ë³òàö³ÿ íà ïðàêòèö³”, ùî ñòîñóþòüñÿ îïóáë³-
êîâàíèõ ðîá³ò òà êîðîòêèõ äîïîâ³äåé. Îáëàñò³ ³íòå-
ðåñ³â: âñòàíîâëåííÿ ö³ëåé, îïèñè âòðó÷àíü, äîêà-
çîâà ðåàá³ë³òàö³ÿ, òåîðåòè÷íà áàçà äëÿ ðåàá³ë³òàö³¿.
Ðåäàêòîð çàâæäè âèçíà÷àº, ÷è º ñòàòòÿ àêòóàëü-
íîþ äëÿ ïðàêòèêóþ÷îãî êë³í³öèñòà áóäü-ÿêî¿ ïðî-
ôåñ³¿. ³í îõîïëþº ôóíêö³îíàëüí³ ðîçëàäè, âñ³ â³êè,
áóäü ÿêå âòðó÷àííÿ òà âñ³ ìåòîäè. ³äêðèòèé äî-
ñòóï äîñòóïíèé çà ïëàòó.
International Journal of Rehabilitation Research
Æóðíàë ³íäåêñóºòüñÿ â PubMed / MEDLINE.
Science Citation Index Expanded. Social Sciences Ci-
tation Index, Current Contents (Social & Behavioural
Sciences and Clinical Medicine), Scopus, SCImago,
Engineering information òà PsycINFO. Â³í º ÷ëåíîì
Committee on Publication Ethics (COPE), ìåòîþ ÿêî-
ãî º âèçíà÷åííÿ íàéêðàùî¿ ïðàêòèêè åòèêè íàóêîâèõ
ïóáë³êàö³é (www.publicationethics.org). Êàòåãîð³¿
ðîá³ò âêëþ÷àþòü: îðèã³íàëüí³ ñòàòò³, îãëÿäîâ³ ñòàòò³,
êîðîòê³ äîïîâ³ä³, êë³í³÷í³ âèïàäêè òà ëèñòè. Îáëàñò³
³íòåðåñ³â: ôóíêö³îíóâàííÿ òà îáìåæåííÿ æèòòºä³ÿëü-
íîñò³ ïðîòÿãîì óñüîãî æèòòºâîãî öèêëó; ðåàá³ë³-
òàö³éí³ ïðîãðàìè äëÿ îñ³á ç ô³çè÷íèìè, ñåíñîðíèìè,
ïñèõ³÷íèìè îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà îá-
ìåæåííÿìè æèòòºä³ÿëüíîñò³, ùî ïîâ’ÿçàí³ ç ðîçâèò-
êîì, âèì³ðþâàííÿ ôóíêö³îíóâàííÿ òà îáìåæåíü
æèòòºä³ÿëüíîñò³, ñïåö³àëüíà îñâ³òà òà ïðîôåñ³éíà
ðåàá³ë³òàö³ÿ, îáëàäíàííÿ, äîñòóïí³ñòü òà òðàíñïîð-
òóâàííÿ, ³íôîðìàö³éí³ òåõíîëî㳿, íåçàëåæíå æèòòÿ,
ñïîæèâ÷³, þðèäè÷í³, åêîíîì³÷í³ òà ñîö³àëüíî-ïîë³-
òè÷í³ àñïåêòè ôóíêö³îíóâàííÿ, îáìåæåíü æèòòºä³-
ÿëüíîñò³ òà êîíòåêñòóàëüíèõ ôàêòîð³â. Æóðíàë äî-
ñòóïíèé ÷åðåç ³íäèâ³äóàëüíó òà ³íñòèòóö³éíó
ïåðåäïëàòó, ÿêà äîñòóïíà ÷åðåç Ovid ó çàêëàäàõ ïî
âñüîìó ñâ³òîâ³.
Physikalische Medisin – Rehabilitationsmedis in –
Kurortmedisin - Journal of Physical and
Rehabilitation Medicine (JPRM)
Æóðíàë ³íäåêñóºòüñÿ â Scopus òà Science
Citation Index Expanded. Êàòåãî𳿠ðîá³ò âêëþ÷à-
þòü: îðèã³íàëüí³ äîñë³äæåííÿ, êë³í³÷í³ âèïàäêè òà
îãëÿäè, íàñòàíîâè òà îñâ³òí³ ñòàòò³, ìàòåð³àëè äëÿ
áåçïåðåðâíî¿ ìåäè÷íî¿ îñâ³òè, òåçè êîíãðåñ³â, íî-
âèíè òîâàðèñòâà, ðåäàêö³éí³ ìàòåð³àëè òà ðåçþìå
îñòàíí³õ äîñë³äæåíü. Îáëàñò³ ³íòåðåñ³â: íàóêîâ³ òà
îñâ³òí³ ñòàòò³ ÿê ó ô³çè÷í³é ìåäèöèí³, òàê ³ â ðåàá³-
ë³òàö³¿. Ðåöåíçîâàí³ òà ïðèéíÿò³ ñòàòò³ ïóáë³êóþòü-
ñÿ â ²íòåðíåò³ ïåðåä äðóêîì, äëÿ çàáåçïå÷åííÿ
øâèäêîãî ïîøèðåííÿ çíàíü.
Rehabilitació n (Madr.) (RM)
Æóðíàë ³íäåêñóºòüñÿ â Eventline, Bibliomed,
Sedbase, Cumulative Index to Nursing and Allied

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 93
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Ìàëþíîê 2. Øëÿõè ïîë³òè÷íîãî âïëèâó íà Âñåñâ³òíþ îðãàí³çàö³þ îõîðîíè çäîðîâ’ÿ (ÂÎÎÇ) íåóðÿäîâèìè îðãàí³çàö³ÿìè (ÍÓÎ)
øëÿõîì îô³ö³éíèõ â³äíîñèí. CST: Êëàñèô³êàö³ÿ. Òåðì³íîëîã³ÿ. Ñòàíäàðòè; DAR: Îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà ðåàá³ë³òà-
ö³ÿ; ISPRM: ̳æíàðîäíå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè; ÂÎÎÇ: Âñåñâ³òíÿ îðãàí³çàö³ÿ îõîðîíè çäîðîâ’ÿ;
Àäàïòîâàíî ç: Reinhardt JD, Von Groote PM, Delisa JA, John L, Bickenbach JE, Li LSW. Chapter 3: International non-governmental
organizations in the emerging world society: the example of ISPRM. J Rehabil Med Preview, 2009; (6), 810-22. http://doi.org/10.2340/
16501977-0430

Health Literature (CINAHL), Scopus, Pascal òà
Indice Bibliogràfico Español en Ciencias de la Salud
(IBECS). Êàòåãî𳿠ðîá³ò âêëþ÷àþòü: îðèã³íàëüí³
ñòàòò³, îãëÿäè, êë³í³÷í³ âèïàäêè, ëèñòè äî ðåäàêòî-
ðà, ñïåö³àëüí³ ñòàòò³ òà ðåäàêö³éí³ ñòàòò³. Éîãî
îñíîâíà ìåòà ïîëÿãຠâ íàäàíí³ äîêàçîâî¿ áàçè äëÿ
ïîë³ïøåííÿ ì³æäèñöèïë³íàðíî¿ ðåàá³ë³òàö³éíî¿ äî-
ïîìîãè. Òàêèì ÷èíîì, ñôåðà çàñòîñóâàííÿ æóðíà-
ëó âêëþ÷ຠêë³í³÷í³ òà ôóíäàìåíòàëüí³ íàóêîâ³
äîñë³äæåííÿ â ãàëóç³ ðåàá³ë³òàö³¿, ÿê³ ìîæóòü ïî-
êðàùèòè çíàííÿ òà íàâè÷êè ÷èòàöüêî¿ àóäèòîð³¿
(ô³ç³àòðè, ô³çè÷í³ òåðàïåâòè, åðãîòåðàïåâòè òà ³íø³
ôàõ³âö³ îõîðîíè çäîðîâ’ÿ). Æóðíàë íàäñèëàºòüñÿ
âñ³ì ÷ëåíàì SERMEF (ùî ñêëàäຠá³ëüøå í³æ 1700
ïðîôåñ³îíàë³â). Íà äàíèé ìîìåíò â³í íå ìຠâ³äêðè-
òîãî äîñòóïó, ëèøå äëÿ äåÿêèõ êîíêðåòíèõ ñòàòåé.
Disability and Rehabilitation
“Disability and Rehabilitation” òà “Disability along
with Rehabilitation: Assistive Technology” – º ì³æíà-
ðîäíèìè ìóëüòèäèñöèïë³íàðíèìè æóðíàëàìè, ÿê³
ñïðÿìîâàí³ íà çàîõî÷åííÿ äî êðàùîãî ðîçóì³ííÿ
âñ³õ àñïåêò³â îáìåæåíü æèòòºä³ÿëüíîñò³ òà ïðîïà-
ãóâàííÿ ðåàá³ë³òàö³éíî¿ íàóêè, ïðàêòèêè òà ïîë³òè÷-
íèõ àñïåêò³â ðåàá³ë³òàö³éíîãî ïðîöåñó. Disability and
Rehabilitation ïóáë³êóº îãëÿäè, äîñë³äíèöüê³ ñòàòò³,
ðàçîì ç ðîçä³ëàìè “Ðåàá³ë³òàö³ÿ íà ïðàêòèö³”,
“Ïåðñïåêòèâè ðåàá³ë³òàö³¿” òà “Êë³í³÷í³ âèïàäêè”,
à òàêîæ íåðåãóëÿðíî - Ëèñòè. Ïóáë³êàö³¿, îð³ºíòî-
âàí³ íà äîïîì³æí³ òåõíîëî㳿, îñîáëèâî ï³äõîäÿòü
äëÿ Disability and Rehabilitation: Assistive
Technology, çàîõî÷óþòüñÿ ìàòåð³àëè, ùî îõîïëþ-
þòü øèðîêèé ñïåêòð òåì ïðî îáìåæåííÿ æèòòº-
ä³ÿëüíîñò³ òà ðåàá³ë³òàö³þ â³ä äîñë³äíèê³â òà ïðàê-
òèê³â â óñ³õ äèñöèïë³íàõ, ÿê³ ïðàöþþòü ó ö³é ãàëóç³.
Æóðíàëè â³òàþòü ÿê ê³ëüê³ñí³, òàê ³ ÿê³ñí³ äîñë³ä-
æåííÿ, à òàêîæ ìóëüòèäèñöèïë³íàðí³ îáçîðè äëÿ
îõîïëåííÿ øèðîêîãî êîëà ïðîôåñ³îíàë³â. Îáèäâà
æóðíàëè ïóáë³êóþòü ñïåö³àëüí³ âèïóñêè, ùî ðåöåí-
çóþòüñÿ â³äïîâ³äíèì ÷èíîì.
Ðîëü ªâðîïè ó çàõîäàõ ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
ó âñüîìó ñâ³òîâ³
Îðãàí³çàö³ºþ – ïàðàñîëüêîþ ÔÐÌ ë³êàð³â ó
âñüîìó ñâ³òîâ³ º International Society of Physical and
Rehabilitation Medicine (ISPRM)30.
ISPRM ìຠòðè ìàíäàòè: ãóìàí³òàðíèé ÷è öè-
â³ëüíî-ñóñï³ëüíèé, ïðîôåñ³éíèé òà íàóêîâèé31,32.

94 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018

Äëÿ äîñÿãíåííÿ ñâî¿õ ö³ëåé ISPRM ñïî÷àòêó ñïè-
ðàºòüñÿ íà ñâîº ÷ëåíñòâî, ùî âêëþ÷ຠ÷ëåí³â íà-
ö³îíàëüíèõ òîâàðèñòâ, âêëþ÷àþ÷è óñ³ ºâðîïåéñüê³
òîâàðèñòâà ÔÐÌ, à òàêîæ ³íäèâ³äóàëüíèõ ÷ëåí³â.
Êð³ì òîãî, ISPRM ñï³âïðàöþº ç ðåã³îíàëüíèìè
îðãàíàìè, â òîìó ÷èñë³ ç ªâðîïåéñüêîþ àêàäå쳺þ
ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ªÀÐÌ), ªâðîïåéñüêèì
òîâàðèñòâîì ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
(ªÒÔÐÌ) òà Ñåêö³ºþ Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³-
àë³ñò³â (Ñåêö³ÿ ÔÐÌ ªÑÌÑ) çà äîïîìîãîþ óãîäè
ïðî âçàºìíå âèçíàííÿ òà ñï³ëüíèé ðîáî÷èé ïëàí. Çà
ìåæàìè ñôåðè ÔÐÌ, ISPRM ñï³âïðàöþº ç ³íøèìè
íåäåðæàâíèìè îðãàí³çàö³ÿìè, à ãîëîâíå - ç Âñå-
ñâ³òíüîþ îðãàí³çàö³ºþ îõîðîíè çäîðîâ’ÿ (ÂÎÎÇ)
(Ìàëþíîê 2)32.
Âàæëèâó ðîëü â³ä³ãðàþòü ðåã³îíàëüí³ ôîðóìè:
The North and Baltic Forum of PRM, ùî âêëþ÷ຠïðè-
ëåãë³ ðåã³îíè â ϳâí³÷í³é ªâðîï³, òàê³ ÿê Ðîñ³ÿ, Óêðà¿-
íà òà The Mediterranean Forum of PRM, ùî âêëþ-
÷ຠâåñü ðåã³îí Ñåðåäçåìíîìîðñüêîãî áàñåéíó.
Îñíîâîþ îô³ö³éíèõ â³äíîñèí ç ÂÎÎÇ º âçàºìî-
óçãîäæåíèé òðèð³÷íèé ïëàí ñï³âïðàö³, â³äïîâ³äíî äî
ÿêîãî ùîòðèð³÷íî Âèêîíàâ÷îþ Ðàäîþ ÂÎÎÇ
â³äáóâàºòüñÿ ïåðåãëÿä ðåçóëüòàò³â. Íàéâàæëèâ³ø³
ñó÷àñí³ òåìè ïëàíó ñï³âïðàö³ âêëþ÷àþòü çàãàëü-
íîñèñòåìíå âïðîâàäæåííÿ ̳æíàðîäíî¿ êëàñèô³-
êàö³¿ ôóíêö³îíóâàííÿ, îáìåæåííÿ æèòòºä³ÿëüíîñò³
òà çäîðîâ’ÿ (ÌÊÔ) â Ô³çè÷íó òà Ðåàá³ë³òàö³éíó
Ìåäèöèíó, ñèñòåìè ðåàá³ë³òàö³¿ òà îõîðîíè çäîðî-
â’ÿ â ö³ëîìó, ñòâîðåííÿ íàâ÷àëüíî¿ ñèñòåìè îõî-
ðîíè çäîðîâ’ÿ ó ð³çíèõ êðà¿íàõ ñâ³òó, íà ïðèêëàä³
ñèòóàö³¿ ëþäåé, ùî æèâóòü ç òðàâìàìè ñïèííîãî
ìîçêó33 òà ïîñèëåííÿ ðåàá³ë³òàö³éíèõ ïîñëóã ó âñüî-
ìó ñâ³òîâ³ 34. Âàæëèâèì âíåñêîì ªâðîïè â êîí-
òåêñò³ ïîòî÷íîãî ïëàíó ñï³âïðàö³ º ðîçðîáêà íàö³î-
íàëüíèõ ñèñòåì óïðàâë³ííÿ ÿê³ñòþ ðåàá³ë³òàö³¿35,
âêëþ÷àþ÷è ñïåöèô³êàö³¿ ðåàá³ë³òàö³éíèõ ñëóæá ç
âèêîðèñòàííÿì ̳æíàðîäíî¿ êëàñèô³êàö³¿ îðãàí³-
çàö³¿ ïîñëóã äëÿ ðåàá³ë³òàö³¿ (International
Classification of Service Organisations For
Rehabilitation, ICSO-R)36, Ïðîöåäóð êë³í³÷íîãî îö³-
íþâàííÿ37, âïðîâàäæåííÿ â ìàñøòàáàõ âñ³º¿ ªâðî-
ïè êóëüòóðàëüíî àäàïòîâàíèõ âåðñ³é ³íñòðóìåíò³â
Ïðîöåäóð êë³í³÷íîãî îö³íþâàííÿ35,38,39 òà ðîçðîá-
êè ìåòðèê äëÿ ñòàíäàðòèçîâàíî¿ çâ³òíîñò³ ç äàíèõ,
ç³áðàíèõ çà äîïîìîãîþ ðÿäó ³íñòðóìåíò³â çáîðó
äàíèõ35,40-42. Íàéãîëîâí³øå, Ñåêö³ÿ òà Ðàäà ÔÐÌ
ªÑÌÑ çàéìàþòüñÿ ðîçðîáêîþ åòàëîííèõ ðåàá³ë³-
òàö³éíèõ ïîñëóã, áåðó÷è íà ñåáå çîáîâ’ÿçàííÿ íà-
äàâàòè ïîðàäè òà äåìîíñòðàö³¿ ë³êàðÿì ÔÐÌ íà
ì³ñöÿõ òà îðãàí³çàö³ÿì îõîðîíè çäîðîâ’ÿ ïî âñüî-
ìó ñâ³òîâ³. Ó êîíòåêñò³ íàøî¿ ñïåö³àëüíîñò³, ÿêà º
â êîíòåêñò³ âíóòð³øíüîïîë³òè÷íîãî ïîðÿäêó äåííî-
ãî ÔÐÌ, ªâðîïåéñüê³ Îðãàíè òà íàö³îíàëüí³ òîâà-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 5 – ÎÐÃÀͲÇÀÖ²¯ ÔÐÌ Â ªÂÐÎϲ: ÑÒÐÓÊÒÓÐÀ ÒÀ IJßËÜͲÑÒÜ
ðèñòâà çàëó÷åí³ äî ïîäàëüøîãî ðîçâèòêó ñïèñêó
òåì íàóêîâèõ êîíãðåñ³â, ÿê îñíîâíîãî åëåìåíòó
ïîáóäîâè ³äåíòè÷íîñò³ òà îñíîâíèõ êîìïåòåíòíî-
ñòåé ÔÐÌ. Äîäàòêîâî, 8 æóðíàë³â º àêòèâíèìè
÷ëåíàìè “²íòåðíåò-æóðíàëó ISPRM”.
Íàéâàæëèâ³øîþ ³í³ö³àòèâîþ îðãàí³â ÔÐÌ â
ªâðîï³ º ðîçâèòîê Êîêðàí³âñüêî¿ ðåàá³ë³òàö³éíî¿
ñôåðè. (äîêëàäí³øå äèâ. Ðîçä³ë 11)43.
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18. Abstracts from the 1st Baltic and North Sea Conference on
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35. Stucki G., Zampolini M., Juocevicius A., Negrini S., Christo-
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2016 Jun;52(3):417–8.

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Mauro Zampolini,
Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner,
Carlotte Kiekens, Sasa Moslavac, Enrique Varela-Donoso, Anthony B Ward, Stefano Negrini.
• Ó÷àñíèêè: Nicolas Christodoulou, Elena M. Ilieva, Jorge Lains, Gerold Stucki, Stefano Negrini, Filipe
Antunes, Nikolaos Barotsis, Kristian Borg, Joaquim Chaler, Christoph Gutenbrunner, Crt Marincek, Xanthi
Michail, Dominic Perennou, Henk J. Stam, Ulrich Smolenski, Peter Takac, Aivars Vetra, Jiri Votava, Derick
T Wade, Daniel Wever, Mauro Zampolini, Hermina Damjan, Calogero Foti, Francesca Gimigliano, Jolanta
Kujawa, Alessandro Giustini, Caterina Pistarini, Anthony B Ward, Alain Yelnik.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ

96 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 5 – ÎÐÃÀͲÇÀÖ²¯ ÔÐÌ Â ªÂÐÎϲ: ÑÒÐÓÊÒÓÐÀ ÒÀ IJßËÜͲÑÒÜ

Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

(ÔÐM) â ªâðîï³.
Ðîçä³ë 6 – Çíàííÿ òà íàâè÷êè ë³êàð³â ÔÐÌ
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
Ó êîíòåêñò³ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ) â ªâðîï³ öåé äîêóìåíò ðîçãëÿäຠïðèíöèïè
ÔÐÌ ç ô³ç³îëîã³÷íî¿ òî÷êè çîðó, ðîçãëÿäàþ÷è ÿê ô³çè÷í³, òàê ³ ïîâåä³íêîâ³ ìåõàí³çìè ëþäñüêî¿ ³ñòîòè, ÿê³ ëåæàòü â
îñíîâ³ ðîáîòè ë³êàð³â ÔÐÌ. ϳñëÿ îáãîâîðåííÿ ïèòàíü ðîçâèòêó òà åâîëþö³¿ ÔÐÌ, ùî âåäå äî ¿¿ óí³êàëüíîãî òà
ñïåöèô³÷íîãî ï³äõîäó, áóäóòü ðîçãëÿíóò³ íàñòóïí³ ìåõàí³çìè:
– ïðîöåñè ðåïàðàö³¿ (³ âèçíà÷åííÿ ïîòåíö³àëó â³äíîâëåííÿ): ïðîöåñè ðåïàðàö³¿ ïåðåâàæíî ïîâ’ÿçàí³ ç ê³ëüê³ñòþ ³ ³ñòî-
ð³ºþ ðîçâèòêó çàõâîðþâàíü òà ïîðóøåíü, òèì ÷àñîì, ÿê ïîòåíö³àë â³äíîâëåííÿ òàêîæ ïîâ’ÿçàíèé ç ³íäèâ³äóàëüíèìè
ôàêòîðàìè òà ôàêòîðàìè ñåðåäîâèùà; ë³êàð³ ÔÐÌ ïðàöþþòü íàä ïîðóøåííÿìè, ùîá ñïðèÿòè âèë³êîâóâàííþ àáî
â³äíîâëåííþ, òà ïðîïîíóþòü ðåàá³ë³òàö³þ, ÿêùî º ïîòåíö³àë â³äíîâëåííÿ: öå ïîâ’ÿçàíî ç ïðîãíîñòè÷íîþ ðîëëþ ë³êàð³â
ÔÐÌ;
– ïðîöåñè íàâ÷àííÿ: ÔÐÌ – öå ñïåö³àëüí³ñòü, ùî íàâ÷ຠíîâèì ô³çè÷íèì çàñîáàì òà ïîâåä³íêîâèì ï³äõîäàì, äëÿ óìîæ-
ëèâëåííÿ íàéêðàùî¿ ó÷àñò³ ïàö³ºíò³â ÷åðåç ïîêðàùåííÿ ïîðóøåíü òà ìîäèô³êàö³¿ àêòèâíîñò³; ç ö³º¿ òî÷êè çîðó, ïðî-
òÿãîì ïðîöåñ³â ðåïàðàö³¿ òà ðåàá³ë³òàö³¿ ë³êàð³ ÔÐÌ òà ðåàá³ë³òàö³éíà êîìàíäà º â÷èòåëÿìè íîâèõ ðóõîâèõ òà ïîâå-
ä³íêîâèõ ñòðàòåã³é;
– êîìïåíñàòîðí³ ïðîöåñè (àäàïòàö³ÿ / àá³ë³òàö³ÿ / ðåàá³ë³òàö³ÿ): ë³êàð³ ÔÐÌ íàâ÷àþòü ïàö³ºíò³â, ÿê àäàïòóâàòèñÿ äî
íîâîãî (íàáóòîãî) ñòàíó çäîðîâ’ÿ, âèêîðèñòîâóþ÷è êîìïåíñàòîðí³ ìåõàí³çìè, ùî ´ðóíòóþòüñÿ íà ³íøèõ ñòðóêòó-
ðàõ / ôóíêö³ÿõ îðãàí³çìó, ïîâåä³íêîâèõ çì³íàõ òà/àáî äîïîì³æíèõ ïðèñòðîÿõ (àáî òåõí³÷íèõ çàñîáàõ) (ïðîòåçàõ ³
îðòåçàõ); ï³ä ÷àñ çðîñòàííÿ ìåòîþ ë³êàð³â ÔÐÌ º çàáåçïå÷åííÿ ïîâíîãî (³ êîìïåíñàòîðíîãî) ðîçâèòêó ³íòàêòíî¿ ôóíêö³¿,
òà ùîá âîíà íå áóëà ïîã³ðøåíà ïåðâèííèì çàõâîðþâàííÿì; êîìïåíñàòîðí³ ïðîöåñè º ïîâ’ÿçàíèìè ç àêòèâí³ñòþ;
– óïðàâë³íñüê³ íàâè÷êè: ë³êàð³ ÔÐÌ – öå ìåíåäæåðè ëþäåé òà ðåñóðñ³â; âîíè êåðóþòü ïàö³ºíòàìè òà ¿õ äîãëÿäà÷àìè,
íàâ÷àþòü ³ äîçâîëÿþòü ¿ì äîñÿãòè ìàêñèìàëüíî ìîæëèâî¿ ó÷àñò³, òàêîæ çîñåðåäæóþ÷èñü íà ï³äòðèìö³; âîíè î÷îëþ-
þòü êîìàíäó ç ìåòîþ çðîáèòè ¿¿ êðàùîþ çàðàäè ïàö³ºíòà; íàðåøò³, âîíè êåðóþòü ðîçïîä³ëîì ðåñóðñ³â äëÿ ôóíê-
ö³îíóâàííÿ ïàö³ºíò³â òà êîìàíäè;
– êîìóí³êàòèâí³ íàâè÷êè: ë³êàð³ ÔÐÌ ïîâèíí³ ðîçâèíóòè äóæå äîáð³ êîìóí³êàòèâí³ íàâè÷êè, ùîá òðåíóâàòè, ³íôîð-
ìóâàòè òà íàâ÷àòè ïàö³ºíò³â òà ¿õí³õ äîãëÿäà÷³â: öå äîçâîëèòü íàáóòòþ â³äïîâ³äíèõ ïîâåä³íêîâèõ çì³í, à òàêîæ ïðà-
âèëüíèõ ô³çè÷íèõ êîìïåíñàö³é.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 6. Knowledge and skills of PRM physicians. Eur J Phys
Rehabil Med. 2018 Apr;54(2):214-229.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 6. Çíàííÿ òà íàâè÷êè ë³êàð³â ÔÐÌ. Óêðà¿íñüêèé
æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 97–112.
Êëþ÷îâ³ ñëîâà: Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà, ªâðîïà, íàâ÷àííÿ, ôóíêö³îíàëüíå â³äíîâëåííÿ, êåéñ-ìåíåäæìåíò,
êîìóí³êàö³ÿ.

Ââåäåííÿ ñïåö³àëüí³ñòþ. Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïî-

Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî
óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³î-
íàëüíîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòå-
ð³àë³â äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìó-
âàííÿ ïðî ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â
ðåàá³ë³òàö³¿ òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà
âàæëèâîñò³ ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ
íÿòòÿ ÔÐÌ, ÷îìó ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì
ëþäÿì ³ ñóñï³ëüñòâó, îñíîâè ÔÐÌ, ³ñòîð³ÿ ñïåö³-
àëüíîñò³ ÔÐÌ, ñòðóêòóðà ³ ä³ÿëüí³ñòü îðãàí³çàö³é
ÔÐÌ â ªâðîï³, çíàííÿ ³ íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà
êë³í³÷íèõ êîìïåòåíòíîñòåé ÔÐÌ, ì³ñöå ñïåö³àëü-
íîñò³ ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ ³
ñóñï³ëüñòâ³, îñâ³òà òà áåçïåðåðâíèé ïðîôåñ³éíèé
ðîçâèòîê ë³êàð³â ÔÐÌ, îñîáëèâîñò³ òà ïðîáëåìè
íàóêè òà äîñë³äæåíü â ÔÐÌ òà ïðîáëåìè òà ïåðñ-
ïåêòèâè ìàéáóòíüîãî ÔÐÌ.
Öåé ðîçä³ë ðîçãëÿäຠïðèíöèïè ÔÐÌ ç ô³ç³îëî-
ã³÷íî¿ òî÷êè çîðó, ðîçãëÿäàþ÷è ÿê ô³çè÷í³, òàê ³
ïîâåä³íêîâ³ ìåõàí³çìè ëþäñüêî¿ ³ñòîòè, ÿê³ ëåæàòü

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 97
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
â îñíîâ³ ðîáîòè ë³êàð³â ÔÐÌ. ϳñëÿ îáãîâîðåííÿ
ïèòàíü ðîçâèòêó òà åâîëþö³¿ ÔÐÌ, ùî âåäå äî ¿¿
óí³êàëüíîãî òà ñïåöèô³÷íîãî ï³äõîäó, áóäóòü ðîç-
ãëÿíóò³ íàñòóïí³ ìåõàí³çìè:
– ïðîöåñè íàâ÷àííÿ: ÔÐÌ – öå ñïåö³àëüí³ñòü, ùî
íàâ÷ຠíîâèì ô³çè÷íèì çàñîáàì òà ïîâåä³íêî-
âèì ï³äõîäàì, äëÿ óìîæëèâëåííÿ íàéêðàùî¿
ó÷àñò³ ïàö³ºíò³â ÷åðåç ïîêðàùåííÿ ïîðóøåíü
òà ìîäèô³êàö³¿ àêòèâíîñò³; ç ö³º¿ òî÷êè çîðó,
ïðîòÿãîì ïðîöåñ³â ðåïàðàö³¿ òà ðåàá³ë³òàö³¿
ë³êàð³ ÔÐÌ òà ðåàá³ë³òàö³éíà êîìàíäà º â÷è-
òåëÿìè íîâèõ ðóõîâèõ òà ïîâåä³íêîâèõ ñòðà-
òåã³é;
– ïðîöåñè ðåïàðàö³¿ (³ âèçíà÷åííÿ ïîòåíö³àëó
â³äíîâëåííÿ): ïðîöåñè ðåïàðàö³¿ ïåðåâàæíî ïî-
â’ÿçàí³ ç ê³ëüê³ñòþ ³ ³ñòîð³ºþ ðîçâèòêó çàõâîðþ-
âàíü òà ïîðóøåíü, òèì ÷àñîì, ÿê ïîòåíö³àë
â³äíîâëåííÿ òàêîæ ïîâ’ÿçàíèé ç ³íäèâ³äóàëüíè-
ìè ôàêòîðàìè òà ôàêòîðàìè ñåðåäîâèùà;
ë³êàð³ ÔÐÌ ïðàöþþòü íàä ïîðóøåííÿìè, ùîá
ñïðèÿòè âèë³êîâóâàííþ àáî â³äíîâëåííþ, òà
ïðîïîíóþòü ðåàá³ë³òàö³þ, ÿêùî º ïîòåíö³àë
â³äíîâëåííÿ: öå ïîâ’ÿçàíî ç ïðîãíîñòè÷íîþ ðîë-
ëþ ë³êàð³â ÔÐÌ;
– êîìïåíñàòîðí³ ïðîöåñè (àäàïòàö³ÿ / àá³ë³òàö³ÿ /
ðåàá³ë³òàö³ÿ): ë³êàð³ ÔÐÌ íàâ÷àþòü ïàö³ºíò³â, ÿê
àäàïòóâàòèñÿ äî íîâîãî (íàáóòîãî) ñòàíó çäî-
ðîâ’ÿ, âèêîðèñòîâóþ÷è êîìïåíñàòîðí³ ìåõàí³-
çìè, ùî ´ðóíòóþòüñÿ íà ³íøèõ ñòðóêòóðàõ /
ôóíêö³ÿõ îðãàí³çìó, ïîâåä³íêîâèõ çì³íàõ òà/àáî
äîïîì³æíèõ ïðèñòðîÿõ (àáî òåõí³÷íèõ çàñîáàõ)
(ïðîòåçàõ ³ îðòåçàõ); ï³ä ÷àñ çðîñòàííÿ ìåòîþ
ë³êàð³â ÔÐÌ º çàáåçïå÷åííÿ ïîâíîãî (³ êîìïåí-
ñàòîðíîãî) ðîçâèòêó ³íòàêòíî¿ ôóíêö³¿, òà ùîá
âîíà íå áóëà ïîã³ðøåíà ïåðâèííèì çàõâîðþâàí-
íÿì; êîìïåíñàòîðí³ ïðîöåñè º ïîâ’ÿçàíèìè ç
àêòèâí³ñòþ;
– óïðàâë³íñüê³ íàâè÷êè: ë³êàð³ ÔÐÌ – öå ìåíåä-
æåðè ëþäåé òà ðåñóðñ³â; âîíè êåðóþòü ïàö³ºí-
òàìè òà ¿õ äîãëÿäà÷àìè, íàâ÷àþòü ³ äîçâîëÿ-
þòü ¿ì äîñÿãòè ìàêñèìàëüíî ìîæëèâî¿ ó÷àñò³,
òàêîæ çîñåðåäæóþ÷èñü íà ï³äòðèìö³; âîíè î÷î-
ëþþòü êîìàíäó ç ìåòîþ çðîáèòè ¿¿ êðàùîþ
çàðàäè ïàö³ºíòà; íàðåøò³, âîíè êåðóþòü ðîçïî-
ä³ëîì ðåñóðñ³â äëÿ ôóíêö³îíóâàííÿ ïàö³ºíò³â òà
êîìàíäè;
– êîìóí³êàòèâí³ íàâè÷êè: ë³êàð³ ÔÐÌ ïîâèíí³ ðîç-
âèíóòè äóæå äîáð³ êîìóí³êàòèâí³ íàâè÷êè, ùîá
òðåíóâàòè, ³íôîðìóâàòè òà íàâ÷àòè ïàö³ºíò³â òà
¿õí³õ äîãëÿäà÷³â: öå äîçâîëèòü íàáóòòþ â³äïî-
â³äíèõ ïîâåä³íêîâèõ çì³í, à òàêîæ ïðàâèëüíèõ
ô³çè÷íèõ êîìïåíñàö³é.
Ìåòîþ öüîãî ðîçä³ëó º äåòàëüíå îáãîâîðåííÿ
óñ³õ öèõ ìåõàí³çì³â ìåäè÷íî¿ ñïåö³àëüíîñò³ ÔÐÌ,
ùî ðîáèòü ë³êàð³â ÔÐÌ ë³êàðÿìè ðåàá³ë³òàö³¿.
98 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Åâîëþö³ÿ, ùî âåäå äî ñó÷àñíèõ
ïðèíöèï³â ÔÐÌ
Òðàäèö³éíî ìåäèöèíà çàñíîâóâàëà ñâîº ë³êóâàí-
íÿ íà âñòàíîâëåíí³ åò³îëîã³÷íîãî ä³àãíîçó, âèçíà-
÷åíí³ ôàðìàêîëîã³÷íîãî àáî õ³ðóðã³÷íîãî ë³êóâàí-
íÿ, òà çðåøòîþ – àíàë³çó ðåçóëüòàò³â, çàñíîâàíèõ
íà òàêèõ âèì³ðþâàííÿõ, ÿê ïîë³ïøåííÿ àíàë³ç³â
êðîâ³ àáî ðàä³îëîã³÷íèõ äàíèõ. Öÿ “àíàòîìî-
êë³í³÷íà” ìîäåëü ñòâîðèëà îñíîâè ìåäè÷íèõ çíàíü
³ òðèâàëî áóëà äîì³íóþ÷îþ, à ÷àñîì íàâ³òü åêñê-
ëþçèâíîþ ìîäåëëþ ó ìåäè÷í³é ïðàêòèö³ òà íà-
â÷àíí³. Öÿ ìîäåëü ´ðóíòóºòüñÿ íà íàñòóïí³é
ëîã³÷í³é ïîñë³äîâíîñò³: åò³îëîã³ÿ àáî ïðè÷èíè, ùî
ïðèçâîäÿòü äî çàõâîðþâàííÿ, ùî ïðîÿâëÿþòüñÿ
êë³í³÷íèìè ñèìïòîìàìè òà ëàáîðàòîðíèìè çíàõ³ä-
êàìè. ˳êàð³ øóêàëè àíàòîì³÷íî îáìåæåíå ïîõîä-
æåííÿ äëÿ ñòàí³â (ó âèãëÿä³ ïîøêîäæåííÿ òêàíèí,
îòæå, ì³ñöÿ ïàòîëî㳿) ³ çáåðåãëè ïîíÿòòÿ íîçîëî㳿
(êëàñèô³êàö³ÿ õâîðîá). Öÿ êëàñèô³êàö³ÿ õâîðîá 䳺
çàðàç, ÿê ÌÊÕ-Õ (³ ÌÊÕ – XI, ùî î÷³êóº ïóáë³-
êàö³¿)1. Öÿ àíàòîìî-êë³í³÷íà ìîäåëü çîñåðåäæåíà
íà õâîðîá³, ³ ÿê âèÿâèëîñÿ, º äóæå åôåêòèâíîþ äëÿ
ìåäè÷íî¿ ä³àãíîñòèêè òà â êîíòåêñò³ ãîñòðèõ çàõ-
âîðþâàíü, äëÿ ÿêèõ º åò³îòðîïíå ë³êóâàííÿ (åò³î-
ëî㳿 àáî ïðè÷èíè) àáî ñèìïòîìàòè÷íå ë³êóâàííÿ
(ñèìïòîì³â àáî ïðîÿâ³â). Òèì íå ìåíø, öåé ï³äõ³ä
º íåïðèäàòíèv, êîëè íå ³ñíóº ë³êóâàííÿ, à ðåçóëü-
òàòîì õâîðîáè º îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà
ô³çè÷í³ âàäè (ìîäåëü ÌÊÏ 1980 ðîêó), àáî îáìå-
æåííÿ àêòèâíîñò³ òà îáìåæåííÿ ìîæëèâîñò³ ó÷àñò³
(ìîäåëü ÌÊÔ 2001 ðîêó)2, îñîáëèâî (àëå íå ò³ëüêè)
ïðè âàæêèõ ãîñòðèõ ñòàíàõ ç òðèâàëèìè íàñë³äêà-
ìè òà íåçâîðîòíîþ ïàòîëî㳺þ.
Ìîäåëü, ùî â³äîìà ÿê “ôóíêö³îíàëüíà”, çîñå-
ðåäæóº óâàãó íå íà õâîðîá³, à íà ïàö³ºíò³, îïèñóþ-
÷è îáìåæåííÿ ôóíêö³îíóâàííÿ òà ôàêòîðè ñåðåäî-
âèùà (îñîáèñò³ òà ñåðåäîâèùà). ² öå ñàìå º
ïàðàäèãìîþ, ÿêà ö³êàâèòü ë³êàð³â ÔÐÌ, îñê³ëüêè
ôîêóñ âòðó÷àííÿ – íå ëèøå åò³îëîã³÷íà ïðè÷èíà
õâîðîáè, àëå ¿¿ íàñë³äêè ó ôóíêö³îíóâàíí³ îñîáè. Öÿ
ìîäåëü º á³ëüø äîðå÷íîþ äëÿ îïèñó òà àíàë³çó
õðîí³÷íèõ ñòàí³â òà ¿õ òåðàﳿ, îñê³ëüêè âîíà ðîçã-
ëÿäຠñèòóàö³þ îáìåæåíü æèòòºä³ÿëüíîñò³, ÿê íå-
â³äïîâ³äí³ñòü ì³æ ïåðñîíîþ, ñåðåäîâèùåì òà îñî-
áèñòèìè áàæàííÿìè (ïðîåêòàìè)3. Òåðàïåâòè÷í³
âòðó÷àííÿ íå ñïðÿìîâàí³ íà ë³êóâàííÿ ïàö³ºíòà
ò³ëüêè øëÿõîì òåðàﳿ çàõâîðþâàííÿ òà ïîðóøåíü:
âîíè òàêîæ ñïðÿìîâàí³ íà îáìåæåííÿ àêòèâíîñò³
òà îáìåæåííÿ ìîæëèâîñò³ ó÷àñò³. Òîìó 䳿 ô³çè÷-
íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè (ÔÐÌ) çîñåðåä-
æåí³ íà òðüîõ ö³ëÿõ: ïåðøà, ³íäèâ³äóóì, ñïðèÿþ÷è
íå ëèøå ïðîöåñó ðåïàðàö³¿ (õâîðîáè òà ïîðóøåíü),
àëå é êîìïåíñàòîðíèì ïðîöåñàì (âíóòð³øí³ì –
êîìïåíñàö³ÿ, ùî ðîçâèíóòà ïåðñîíîþ, àáî
¹2(2) *2018

çîâí³øí³ì – ç çîâí³øí³ìè ïðèñòðîÿìè); äðóãà, ñå-
ðåäîâèùå (ô³çè÷íå, ïåðñîíàëüíå ïðîôåñ³éíå òîùî)
òà, íàðåøò³, ³íäèâ³äóàëüí³ ïðîåêòè (îñâ³òà, ðîáîòà,
îñîáèñòå òà ñîö³àëüíå æèòòÿ), ÿê³ áóäóòü çì³íåí³
òà àäàïòîâàí³.
ÌÊÔ: êëþ÷îâå ïîíÿòòÿ äëÿ ÔÐÌ
Ìåäè÷íà ñïåö³àëüí³ñòü ÔÐÌ ïðèéíÿëà ̳æíà-
ðîäíó êëàñèô³êàö³þ ôóíêö³îíóâàííÿ, îáìåæåíü
æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ), ðîçðîáëåíó
Âñåñâ³òíüîþ îðãàí³çàö³ºþ îõîðîíè çäîðîâ’ÿ2. Öÿ
êëàñèô³êàö³ÿ âêëþ÷ຠíîâèé ï³äõ³ä äî ëþäåé ç îá-
ìåæåííÿìè æèòòºä³ÿëüíîñò³, ùî ñïèðàºòüñÿ íà
áàãàòîâèì³ðíèé ï³äõ³ä4. Ïðèêëàäîì çàñòîñóâàííÿ
òàêîãî ï³äõîäó º ³äåíòèô³êàö³ÿ óðàæåííÿ (åò³îëî㳿)
çà äîïîìîãîþ ñó÷àñíèõ ìåòîä³â â³çóàë³çàö³¿, ÿê³
äîçâîëÿþòü ïîáà÷èòè ïîäðîáèö³ ïîøêîäæåíèõ
òêàíèí òà âèÿâëåííÿ ñòðóêòóð, ùî íå ïîñòðàæäà-
ëè, òà ÿê³ ìîæóòü áóòè âèêîðèñòàí³ â ïðîöåñ³ ðåà-
á³ë³òàö³¿. Âèêëèêîì äëÿ ë³êàðÿ ÔÐÌ º ðîçãëÿä öèõ
çíàõ³äîê äëÿ ïðîïîíóâàííÿ ìåòîä³â ðåàá³ë³òàö³¿, ÿê³
ìîæóòü ñïðèÿòè ïëàñòè÷íîñò³ òà ðåãåíåðàö³¿. Äðó-
ãèì àñïåêòîì º îö³íþâàííÿ ð³çíèõ ñòðóêòóð òà
ôóíêö³é îðãàí³çìó ç âèêîðèñòàííÿì êë³í³÷íîãî îã-
ëÿäó òà âèáðàíèõ øêàë îö³íþâàííÿ. Äëÿ ë³êàðÿ
ÔÐÌ îäí³ºþ ìåòîþ º âèì³ðþâàííÿ òÿæêîñò³ ïîðó-
øåííÿ òà âèçíà÷åííÿ òî÷íîãî ñï³ââ³äíîøåííÿ ì³æ
ïîðóøåííÿìè òà îñíîâíèìè ïîøêîäæåííÿìè. Öåé
àíàòîìî-êë³í³÷íèé ï³äõ³ä º îñîáëèâî âàæëèâèì ïðè
ì’ÿçîâî-ñêåëåòíèõ òà íåâðîëîã³÷íèõ ðîçëàäàõ, à
òàêîæ ïðè êîãí³òèâíèõ âòðàòàõ âíàñë³äîê ôîêàëü-
íèõ ïîøêîäæåíü. Òðåò³ì àñïåêòîì º îö³íþâàííÿ
îáìåæåíü àêòèâíîñò³. Öå º îñíîâîþ ÔÐÌ, ÿêà
ââàæຠçàëèøêîâ³ çä³áíîñò³ îñ³á ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³, á³ëüø âàæëèâèìè, í³æ ïîðóøåí-
íÿ ñòðóêòóð òà ôóíêö³é îðãàí³çìó. Öå á³ëüø ïîçè-
òèâíå áà÷åííÿ, ïîêëàäàòèñü íà ñàìó àêòèâí³ñòü.
×åòâåðòèé ð³âåíü â³äïîâ³äຠîö³íþâàííþ ñîö³àëü-
íèõ íàñë³äê³â òðàâìè àáî õâîðîáè5. Ó öüîìó êîí-
òåêñò³ òåðì³íè “íåäîë³ê” òà “ô³çè÷íà âàäà”, ÿê³
âèêîðèñòîâóâàëè ðàí³øå, áóëè çàì³íåí³ íà á³ëüø
ïîçèòèâíèé òåðì³í ó÷àñòü, ñòàâëÿ÷è ïàö³ºíòà äî
êîíòåêñòó éîãî/¿¿ îñîáèñòîãî, ïðîôåñ³éíîãî òà ñîö³-
àëüíîãî æèòòÿ. ÌÊÔ òàêîæ º ãàðíîþ ìîäåëëþ äëÿ
ðåàá³ë³òàö³éíèõ ñòðàòåã³é6. Âèì³ðè ÌÊÔ òàêîæ
ìîæóòü ïîñèëàòèñÿ íà ÷³òê³ ö³ë³ àáî âèì³ðþâàííÿ
ðåçóëüòàò³â ðåàá³ë³òàö³¿. “Ñòðóêòóðè îðãàí³çìó/
ïîðóøåííÿ” ìîæóòü â³äïîâ³äàòè ìîæëèâîñòÿì
ñòèìóëÿö³¿ íåïîøêîäæåíèõ ñòðóêòóð çà äîïîìîãîþ
òåõí³ê àáî òåðàï³é, ùî ñòèìóëþþòü çäàòí³ñòü äî
ïëàñòè÷íîñò³7,8. “Ôóíêö³¿ îðãàí³çìó / ïîðóøåííÿ”
ìîæóòü â³äïîâ³äàòè â³äíîâëåííþ òàêèõ ôóíêö³é, ÿê
ñèëà, êîîðäèíàö³ÿ, àáî ñïðèòí³ñòü ó âèïàäêó ðóõî-
âî¿ ôóíêö³¿; äèñêðèì³íàö³ÿ àáî ³äåíòèô³êàö³ÿ ó âè-
ïàäêó ñåíñîðíî¿ ôóíêö³¿; ³ ïëàíóâàííÿ, ñëîâåñíîãî
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 6 – ÇÍÀÍÍß ÒÀ ÍÀÂÈ×ÊÈ Ë²ÊÀв ÔÐÌ
ðîçóì³ííÿ, çàïàì’ÿòîâóâàííÿ äëÿ ï³çíàâàëüíèõ
ôóíêö³é. “Àêòèâí³ñòü / îáìåæåííÿ” ìîæóòü â³äïî-
â³äàòè çíèæåííþ îáìåæåíü æèòòºä³ÿëüíîñò³ òà
ìîæëèâîãî ðîçïîâñþäæåííÿ ôóíêö³îíàëüíîãî
â³äíîâëåííÿ íà ³íø³ àêòèâíîñò³ òà ïîñèëåííÿ îáìå-
æåíü àêòèâíîñò³ êîìïåíñàö³ºþ. “Ó÷àñòü / îáìå-
æåííÿ ìîæëèâîñò³” â³äïîâ³äຠçìåíøåííþ íå-
äîë³ê³â ñîö³àëüíèìè âòðó÷àííÿìè, ùî ´ðóíòóþòüñÿ
íà âèçíàíí³ òà ³íêëþ糿, âðàõîâóþ÷è îñîáèñò³ ôàê-
òîðè òà ôàêòîðè ñåðåäîâèùà. Íåîáõ³äíî âðàõîâó-
âàòè “êîíòåêñòóàëüí³ ôàêòîðè” òà ¿õ ìîæëèâó ðîëü,
ÿê ñïðèÿòëèâèõ ÷èííèê³â òà/àáî áàð’ºð³â. Ó êîí-
òåêñò³ ÌÊÔ òàêîæ ñë³ä âðàõîâóâàòè, ùî ðîçâèòîê
çäàòíîñò³ íå îáîâ’ÿçêîâî â³äïîâ³äຠê³íöåâîìó
âèêîíàííþ ä³é ïàö³ºíòîì, ùî â áóäü-ÿêîìó âèïàä-
êó ìຠáóòè ê³íöåâèì êðîêîì ä³é ÔÐÌ.
Öåé áàãàòîâèì³ðíèé ï³äõ³ä äî õâîðîáè òà ¿¿
íàñë³äê³â äëÿ ä³àãíîñòèêè, ë³êóâàííÿ òà ðåàá³ë³òàö³¿
ïîñèëþþòü ïðèéíÿòòÿ òîãî, ùî ô³çè÷íà òà ðåàá³ë³-
òàö³éíà ìåäèöèíà ìîæå ðîçãëÿäàòèñÿ, ÿê ìåäèöè-
íà äëÿ ëþäñüêî¿ îñîáè ó âçàºìî䳿 ç ìåäèöèíîþ àáî
“îðãàííèìè” ñïåö³àëüíîñòÿìè.
Ïðîöåñè íàâ÷àííÿ ó ô³çè÷í³é
òà ðåàá³ë³òàö³éí³é ìåäèöèí³
Íàâ÷àííÿ º ÷àñòèíîþ ïðîöåñó ðåàá³ë³òàö³¿, ³
îñòàíí³ì ÷àñîì âîíî ìຠá³ëüø âèñîêèé ïðîô³ëü
òà âèçíàííÿ éîãî âàæëèâîñò³ â ïðàêòèö³ ÔÐÌ.
˳êàð ÔÐÌ º â÷èòåëåì, îñîáëèâî, êîëè ðåàá³ë³-
òàö³éí³ ïðîãðàìè ïîâèíí³ áóòè ï³äòðèìàíèìè íîâè-
ìè êîíöåïö³ÿìè àäàïòàö³¿ (íàïð. ïëàñòè÷í³ñòü) òà
ðóõîâîãî íàâ÷àííÿ. Ïðèíöèïè àäàïòàö³¿ òà ïëàñ-
òè÷íîñò³ ðîçãëÿäàþòüñÿ â íàâ÷àëüí³é ïðîãðàì³
ÔÐÌ, ³ ë³êàð³ ÔÐÌ çíàþòü ³ ðîçóì³þòü òåîðåòè÷í³
îñíîâè ïðèíöèï³â âèêëàäàííÿ òà íàâ÷àííÿ10.
ϳä ÷àñ ï³äãîòîâêè ë³êàð³ ÔÐÌ âèâ÷àþòü, ÿê
ëþäè íàâ÷àþòüñÿ ðóõîâèì íàâè÷êàì (ðóõîâå íà-
â÷àííÿ), ³ öå âèìàãຠïðàâèëüíîãî ðîçóì³ííÿ íà-
ñòóïíèõ ôàêòîð³â11:
– Ðóõîâèé ðîçâèòîê: ÿê îòðèìàòè çäàòí³ñòü ðîç-
âèâàòè ðóõîâ³ íàâè÷êè äëÿ ï³äâèùåííÿ ê³íöåâî-
ãî âèêîíàííÿ;
– Ðóõîâèé êîíòðîëü: ÿê íåâðîëîã³÷íà ñèñòåìà
êîíòðîëþº ðóõ;
– Ìîòèâàö³ÿ: ÿê ìîòèâóâàòè ëþäåé áàæàòè íà-
â÷àòèñÿ ðóõîâèì íàâè÷êàì òà áðàòè ó÷àñòü ó
¿õ ïðîãðàì³;
– Íàâ÷àëüíà ïðàêòèêà ô³çè÷íîãî òðåíóâàííÿ: ÿê
ñåðåäîâèùå âòðó÷àííÿ ìîæå îïòèì³çóâàòè çäî-
áóòòÿ ðóõîâèõ íàâè÷îê.
Ö³ çíàííÿ äàþòü çìîãó ë³êàðÿì ÔÐÌ ðîçðîá-
ëÿòè ñòðàòå㳿 äëÿ ïîêðàùåííÿ ðåçóëüòàò³â òà çà-
ïîá³ãàííÿ ïàòîëîã³÷íî¿ àäàïòàö³¿. Åôåêòèâí³ ñó÷àñí³
êîíöåïö³¿ ðóõîâîãî íàâ÷àííÿ òà â³äíîâëåííÿ ðîçâè-
99
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
âàëèñü ç ìåòîþ ñòèìóëþâàòè çäîáóòòÿ íàâè÷îê,
ùî â³äïîâ³äàþòü ïîâñÿêäåííîìó æèòòþ ïàö³ºíòà.
Òàêèé ï³äõ³ä º êîðèñíèì â çàïîá³ãàíí³ ôåíîìåíó
íàâ÷åíîãî íåâèêîðèñòàííÿ òà â³äíîâëåíí³ ôóíêö³¿.
Ïðîòå çàíàäòî ³íòåíñèâíà ïðîãðàìà ìîæå áóòè
êîíòðïðîäóêòèâíîþ ³ íå äîçâîëèòè ïðèðîäí³é
àäàïòàö³¿12. Çàçâè÷àé, íàâ÷àííÿ âêëþ÷ຠâ ñåáå
³íñòðóêö³¿ ïðî “ÿê çðîáèòè ùîñü” / “ÿê âèêîíàòè
çàâäàííÿ”. Íàâ³òü áåç ÿâíî¿ ³íñòðóêö³¿ ëþäèíà ÷à-
ñòî ìຠçäàòí³ñòü ðîçóì³òè, ÿê âèêîíóâàòè çàâäàí-
íÿ, ïðîñòî âèêîðèñòîâóþ÷è íåÿâíå íàâ÷àííÿ.
ßâíå ³ íåÿâíå íàâ÷àííÿ, ÿê ââàæàºòüñÿ, âèêî-
ðèñòîâóºòüñÿ â ð³çíèõ íåðâîâèõ øëÿõàõ. Íåÿâíèé
ïðîöåñ íàâ÷àííÿ º á³ëüø íàä³éíèì ïðè òðàâìàõ
íåðâîâî¿ ñèñòåìè, îñîáëèâî êîëè ïàì’ÿòü ñèëüíî
ïîñòðàæäàëà. Íåçâàæàþ÷è íà òå, ùî â äàíèé ÷àñ
íàé÷àñò³øå âèêîðèñòîâóºòüñÿ ïåðøèé ï³äõ³ä, ÿâí³
òà íåÿâí³ ìåòîäè íàâ÷àííÿ ìàþòü ïîòåíö³àë â óñ³õ
àñïåêòàõ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè13,14.
³äíîâëåííÿ ôóíêö³¿, áóäü òî ñïîíòàííå àáî ï³äñè-
ëåíå âòðó÷àííÿì, º ïîäâ³éíèì ïðîöåñîì ïëàñòè÷-
íîñò³. Âîíè áàãàòî â ÷îìó âçàºìîçàëåæí³, ³ öå
çóìîâëåíî çì³íàìè ÿê íåðâîâî¿, òàê ³ ì’ÿçîâî-ñêå-
ëåòíî¿ ñèñòåì. Ïðîöåñ íåéðîïëàñòè÷íîñò³ çàëå-
æèòü â³ä ì’ÿçîâî¿ àêòèâíîñò³, òîä³ ÿê éîãî âèðà-
æåííÿ çàëåæèòü â³ä íåâðîëîã³÷íî¿ êîìàíäè òà
ðåãóëÿö³¿.
Ó á³ëüø çàãàëüíîìó ñåíñ³, â óñ³õ óìîâàõ, ùî
âïëèâàþòü íà ô³çè÷íó àêòèâí³ñòü, äå º ïîðóøåííÿ
ôóíêö³¿ çàëó÷åííÿ ÷è êîíòðîëþ íàä ì’ÿçîì, àáî äå
º âòðàòà âèêîíàííÿ, çì³öíåííÿ ì’ÿç³â òà ô³çè÷íå
â³äíîâëåííÿ º íåîäì³ííèì, àëå âîíè íå ðîçãëÿäà-
þòüñÿ, ÿê îêðåì³. Âîíè íå ïîâèíí³ áóòè ðîçä³ëåí³ ç
óñ³õ ³íøèõ àñïåêò³â çâè÷àéíî¿ íåéðîìîòîðíî¿ ðåà-
á³ë³òàö³¿, îñê³ëüêè àêòèâí³ñòü òàêîæ îáóìîâëåíà
ïëàñòè÷í³ñòþ15.
Òàêèì ÷èíîì, ë³êàð³ ÔÐÌ îõîïëþþòü öþ íîâó
ôóíêö³îíàëüíó êîíöåïö³þ, ïðàöþþòü ç òåðàïåâòàìè,
ïðîñóâàþ÷è ïîíÿòòÿ ÿê íåâðîëîã³÷íî¿, òàê ³ îðòîïå-
äè÷íî¿ ðåàá³ë³òàö³¿16. Öå âèäíî, íàïðèêëàä, ó âòðó-
÷àííÿõ ç ä³ÿìè òà ñïîñòåðåæåííÿì, òà â çàö³êàâëå-
íîñò³ äî â³ðòóàëüíî¿ ðåàëüíîñò³, ÿêà âñå á³ëüøå
âèêîðèñòîâóºòüñÿ â ðåàá³ë³òàö³éíèõ ïðîãðàìàõ.
Ìîçî÷îê ³ áàçàëüí³ ãàíã볿 º êðèòè÷íèìè äëÿ
ðóõîâîãî íàâ÷àííÿ, ùî äîçâîëÿº ëþäèí³ çäîáóâà-
òè íàâè÷êè ïîâåä³íêè. ßêùî âîíè º ³íòàêòíèìè
ï³ñëÿ ïîøêîäæåíü ìîçêó, öå ìîæëèâî ÷åðåç ïîâòî-
ðþâàíå òðåíóâàííÿ, äëÿ ïîäîëàííÿ òðóäíîù³â ó
âèâ÷åíí³ íîâèõ ðóõîâèõ íàâè÷îê, à òàêîæ îáìåæå-
íîãî ïîñòóðàëüíîãî êîíòðîëþ òà äåô³öèòó ñåíñî-
ìîòîðíî¿ êîîðäèíàö³¿17. Êë³í³öèñòè ÔÐÌ áà÷àòü,
ùî ïîâòîðþâàíà ïðàêòèêà º îñîáëèâ³ñòþ áóäü-
ÿêîãî âòðó÷àííÿ, ÿê ÷àñòèíà ðóõîâîãî íàâ÷àííÿ,
àëå ïðèíöèïè êë³í³÷íî¿ ïðàêòèêè íå ïîâí³ñòþ ´ðóí-
òóþòüñÿ íà ðåçóëüòàòàõ äîñë³äæåíü ðóõîâîãî êîí-
100 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
òðîëþ òà ðóõîâîãî íàâ÷àííÿ ³ ðåàá³ë³òàö³éíî¿ ïðàê-
òèêè. Ïðèêëàäîì ðóõîâîãî íàâ÷àííÿ º ïàðàäèãìè
ðóêè ðîáîòà, äå âèì³ðþºòüñÿ îï³ð ïàö³ºíò³â ï³ä ÷àñ
âèêîðèñòàííÿ ïðèñòðîþ, ùî òðèìàºòüñÿ ðóêîþ,
ïðîòÿãîì ïåâíèõ ðóõ³â ðóêè. ²íøèé ïðèíöèï – öå
âàæëèâà êîíöåïö³ÿ ôàêòè÷íî¿ ê³ëüêîñò³ ïðàêòèêè,
ùî ïðîâîäèòüñÿ ïðîòÿãîì âòðó÷àííÿ â ðàìêàõ
äîñë³äæåííÿ. ²ñíóº âçàºìîçâ’ÿçîê ì³æ âïëèâîì
óòðèìóâàííÿ ïàì’ÿò³, îòðèìàíî¿ âíàñë³äîê âèêî-
íàííÿ ïîâòîðþâàíèõ çàâäàíü ïðîòÿãîì ïåâíîãî
÷àñó, òà îáñÿãîì íàäàíîãî òðåíóâàííÿ18. Íàäì³ðí³
çóñèëëÿ, ñïðÿìîâàí³ íà íàâ÷àííÿ, ìîæóòü ïðèçâå-
ñòè äî çíà÷íîãî ïîë³ïøåííÿ äîâãîòðèâàëîãî çáåð³-
ãàííÿ, àëå ìàëî âïëèâàþòü íà âèêîíàííÿ ³íäèâ³äó-
óìà. Òàêèì ÷èíîì, ë³êàð³ ÔÐÌ ïðèçíà÷àþòü òà
ïðîïîíóþòü ð³çí³ ñõåìè âòðó÷àííÿ, ùîá îá³éòè
íåâ³äïîâ³äí³ñòü ïðîñòîãî ïîâòîðåííÿ ðóõ³â. Çäî-
áóòòÿ ïåðåíàâ÷àííÿ íàâè÷îê âàð³þº, îñê³ëüêè ââà-
æàëîñÿ, ùî ñïðàâæíº â³äíîâëåííÿ ìîçêó âèíèêàº
ò³ëüêè ÷åðåç ïîâòîðåííÿ ïîîäèíö³14. Ìåòîäè êîì-
ïåíñàö³¿ ðîçâèâàþòüñÿ øëÿõîì ÷èñòîãî ïîâòîðåí-
íÿ òà äëÿ òîãî, ùîá äîáèòèñÿ êîðòèêàëüíèõ çì³í
(ñïðàâæíº â³äíîâëåííÿ), îñîáàì ïîâèíí³ íàäàâàòè-
ñÿ á³ëüø ñêëàäí³ çàâäàííÿ. Òåõí³êè ðåàá³ë³òàö³¿
ïîâèíí³ áóòè ñïðÿìîâàí³ íà ñïåöèô³÷í³ ðóõîâ³ äå-
ô³öèòè ïàö³ºíò³â ³, ìîæëèâî, â ïîºäíàí³, íàïðèêëàä,
ç òåðàﳺþ âèìóøåíèìè ðóõàìè ç â³ðòóàëüíîþ
ðåàëüí³ñòþ. Äâà êðèòè÷í³ ïèòàííÿ, ÿê³ ñòàâëÿòüñÿ
äî ðåàá³ë³òàö³éíèõ òåõí³ê, ïîëÿãàþòü ó òîìó, ÷è
çáåð³ãàþòüñÿ çäîáóòêè ïðîòÿãîì çíà÷íîãî ïåð³î-
äó ï³ñëÿ òðåíóâàííÿ òà ÷è âîíè ðîçïîâñþäæóþòü-
ñÿ íà íåòðåíîâàí³ çàâäàííÿ. Ðóõîâå íàâ÷àííÿ ³
ïîâòîðþâàíà ïðàêòèêà, òàêèì ÷èíîì, âèêîðèñòî-
âóþòüñÿ ó ïîñòðàæäàëèõ â³ä ³íñóëüòó òà ÷åðåïíî-
ìîçêîâèõ òðàâì ³ âêëþ÷àþòü14:
– Òðåíóâàííÿ ìîæëèâîñòåé ðóê: òðåíóâàííÿ, ùî
îð³ºíòîâàíå íà ïîðóøåííÿ äëÿ ëåãêîãî ãåì³-
ïàðåçó;
– Òåðàï³ÿ âèìóøåíèìè ðóõàìè;
– Íåðâîâî-ì’ÿçîâà ñòèìóëÿö³ÿ ç åëåêòðîì³îãðà-
ô³÷íîþ ³í³ö³àö³ºþ;
– ²íòåðàêòèâíà ðîáîòî-òåðàï³ÿ;
– Ðåàá³ë³òàö³ÿ íà îñíîâ³ â³ðòóàëüíî¿ ðåàëüíîñò³.
Ðîçóì³ííÿ ïðîöåñ³â ðåïàðàö³¿
òà âèêîðèñòàííÿ êîìïåíñàö³éíèõ ïðîöåñ³â
ó ÔÐÌ äëÿ àäàïòàö³¿, àá³ë³òàö³¿
òà ðåàá³ë³òàö³¿
³äíîâëåííÿ ôóíêö³é, ïîë³ïøåííÿ àêòèâíîñò³ òà
çìåíøåííÿ îáìåæåíü ìîæëèâîñò³ ó÷àñò³ º îñíîâ-
íèìè ö³ëÿìè ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè.
Ö³ ö³ë³ â ïåðøó ÷åðãó ñòîñóþòüñÿ ïàö³ºíò³â ç ðó-
õîâèìè ðîçëàäàìè, ùî º ïåðøîþ ïðè÷èíîþ îáìå-
æåíü æèòòºä³ÿëüíîñò³ ó ñâ³ò³. Ðóõîâå â³äíîâëåííÿ
¹2(2) *2018

â³äïîâ³äຠñïîíòàííîìó àáî ³íäóêîâàíîìó ðåàá³ë³-
òàö³ºþ ïîë³ïøåííþ ðóõîâî¿ ôóíêö³¿, ï³ñëÿ óðàæåíü
ì’ÿçîâî-ñêåëåòíî¿ òà / àáî íåðâîâî¿ ñèñòåìè. Ñïî-
ñòåðåæí³ äîñë³äæåííÿ ùîäî ïðèðîäíîãî â³äíîâëåí-
íÿ ðóõó ï³ñëÿ ³íñóëüòó ïîêàçàëè, ùî êðèâ³ â³äíîâ-
ëåííÿ íå â³äïîâ³äàþòü ë³í³éíîìó ïðîöåñó, àëå
ïåðåâàæíî ïðîõîäÿòü ÷åðåç ïåðøó ôàçó (ïðîòÿãîì
3 ì³ñÿö³â) ç øâèäêèì â³äíîâëåííÿì, òà äðóãó ôàçó
ç á³ëüø ïîâ³ëüíèì ïîêðàùåííÿì ìîòîðíî¿ ôóíêö³¿19
àáî ð³äøå ïî êðîêàõ ³ ïëàòî20.
Ðóõîâå â³äíîâëåííÿ âêëþ÷ຠâ ñåáå äâà êîì-
ïîíåíòè: ñïðàâæíº â³äíîâëåííÿ “per se” ³ êîìïåí-
ñàö³ÿ. Äëÿ ì’ÿçîâî-ñêåëåòíî¿ ñèñòåìè â³äíîâëåí-
íÿ ìîæå îçíà÷àòè “restitutio ad integrum” (ðåä.
ïîâíå â³äíîâëåííÿ), ³íîä³ íàâ³òü àíàòîì³÷íå, çàç-
âè÷àé ôóíêö³îíàëüíî íîðìàëüíå (ç äåÿêèìè çàëèø-
êîâèìè ðóáöÿìè, ùî âèìàãàþòü ïîïåðåäæåííÿ
ìàéáóòí³õ ïîðóøåíü). Íåâðîëîã³÷íî, ñïðàâæíº
ðóõîâå â³äíîâëåííÿ ñòîñóºòüñÿ çàì³ñíî¿ çäàòíîñò³
ðóõîâî¿ ñèñòåìè ëþäèíè äî ïîâíîãî àáî ÷àñòêîâî-
ãî â³äíîâëåííÿ ìîòîðíî¿ ôóíêö³¿ ï³ñëÿ óðàæåííÿ. Öå
º ðåçóëüòàòîì ìåõàí³çì³â ïëàñòè÷íîñò³ ìîçêó íà òë³
ðåãðåñ³¿ ä³àøèçó21, ðåîðãàí³çàö³¿ ïðîòèëåæíî¿ ñåí-
ñîìîòîðíî¿ êîðè ³ çàëó÷åííÿ ï³âêóë³, ÿêà íå ïîñò-
ðàæäàëà22, â³äíîâëåííÿ ïðîâ³äíîñò³ â êîðòèêî –
ñï³íàëüíîìó òðàêò³ àáî â àëüòåðíàòèâíèõ ìîòîð-
íèõ âîëîêíàõ23, çàëó÷åííÿ ïåðåä³ñíóþ÷èõ ñêðîíå-
âî-ëîáíèõ ç’ºäíàíü24 òà ìîäèô³êàö³¿ ì³æï³âêóëüíèõ
çâ’ÿçê³â25.
Êîìïåíñàòîðí³ ìåõàí³çìè ïðèéìàþòüñÿ äëÿ
äîñÿãíåííÿ íàéêðàùîãî ìîæëèâîãî ôóíêö³îíóâàí-
íÿ (àêòèâíîñò³ òà ó÷àñò³), êîëè ïîâíå àíàòîì³÷íå
â³äíîâëåííÿ íå º ìîæëèâèì. Êîìïåíñàö³ÿ ìîæå
ïîêëàäàòèñÿ íà çàëó÷åííÿ àëüòåðíàòèâíèõ ì’ÿç³â
äëÿ âèêîíàííÿ ðóõó (íàïð. ïëå÷îâ³ òà ë³êòüîâ³ ì’ÿçè
äëÿ çàõâàòó ï³ñëÿ ³íñóëüòó26 àáî ì’ÿçè-ðîçãèíà÷³
çàï’ÿñòÿ äëÿ òåíîäåçíîãî çàõâàòó ïðè òåòðàïëå㳿
âíàñë³äîê óðàæåííÿ C627), âèêîðèñòàííÿ êîíòðëà-
òåðàëüíî¿ íå óðàæåíî¿ âåðõíüî¿ ê³íö³âêè àáî çì³íè
ñåðåäîâèùà. ²íøîþ ìîæëèâ³ñòþ äëÿ êîìïåíñàö³¿
º âèêîðèñòàííÿ ³íøî¿ ñòðóêòóðè / ôóíêö³¿ îðãàí³ç-
ìó äëÿ êîìïåíñàö³¿ ïîøêîäæåíî¿ (íàïð. ïðîïð³î-
öåïö³¿ òà çîðó ó âèïàäêó ïîøêîäæåííÿ âíóòð³øíüî-
ãî âóõà ïðè ïîðóøåííÿõ ð³âíîâàãè òà áàëàíñó).
Ïðîòåçè òà îðòåçè º êîìïåíñàòîðíèìè ïðèñòðîÿ-
ìè, ùî øèðîêî âèêîðèñòîâóþòüñÿ â ô³çè÷í³é òà
ðåàá³ë³òàö³éí³é ìåäèöèí³, íàâ³òü ÿêùî âîíè ïîòðå-
áóþòü àäåêâàòíîãî òðåíóâàííÿ òà àêòèâàö³¿ êîì-
ïåíñàòîðíèõ òà/àáî íîâèõ ìîòîðíèõ ôóíêö³é, ùîá
áóòè åôåêòèâíèìè.
Ðóõîâå íàâ÷àííÿ â³äíîñèòüñÿ äî çäàòíîñò³ ðó-
õîâî¿ ñèñòåìè ëþäèíè äî íàâ÷àííÿ øëÿõîì ïðàê-
òèêè òà äîñâ³äó. Ðóõîâå íàâ÷àííÿ âêëþ÷ຠðóõî-
âó àäàïòàö³þ, çäîáóòòÿ íàâè÷îê òà ïðèéíÿòòÿ
ð³øåíü28. Ö³ çäàòíîñò³ ìîæóòü áóòè ìîá³ë³çîâàí³ ó
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 6 – ÇÍÀÍÍß ÒÀ ÍÀÂÈ×ÊÈ Ë²ÊÀв ÔÐÌ
íîðìàëüíèõ îñ³á äëÿ íàáóòòÿ íîâèõ ðóõîâèõ
çä³áíîñòåé, à ó ïàö³ºíò³â – äëÿ ïîë³ïøåííÿ ðóõî-
âîãî â³äíîâëåííÿ.
Ðóõîâà àäàïòàö³ÿ
Äëÿ ë³êàðÿ ÔÐÌ, ðóõîâà àäàïòàö³ÿ ïîâèííà ðî-
çóì³òèñü ó øèðîêîìó çíà÷åíí³.  á³îëîã³÷íîìó
ïëàí³ àäàïòàö³ÿ º ïðîöåñîì çì³íè, çà äîïîìîãîþ
ÿêîãî îðãàí³çì àáî âèä ñòຠêðàùå ï³äõîäèòè äëÿ
ñâîãî ñåðåäîâèùà. Ðóõîâà àäàïòàö³ÿ ç’ÿâëÿºòüñÿ
ÿê ïðîöåñ, çäàòíèé âèðîáëÿòè êðàùèé ïëàí äëÿ
ì³í³ì³çàö³¿ åíåðãåòè÷íèõ âèòðàò òà îïòèì³çàö³¿
åôåêòèâíîñò³ ðóõó íåçàëåæíî â³ä ñåðåäîâèùà òà
ñòàíó ÷èííèêà âïëèâó. Áàãàòî çì³í ñåðåäîâèùà àáî
á³îëîã³÷íèõ çì³í, òàêèõ ÿê çðîñòàííÿ àáî ñòàð³ííÿ,
ïîòðåáóþòü òàêî¿ àäàïòàö³¿. Êð³ì òîãî, â ïðàêòèö³
ÔÐÌ ðóõîâà àäàïòàö³ÿ º íåîáõ³äíîþ, îñê³ëüêè ïà-
òîëîã³÷íèé ïðîöåñ â³äïîâ³äຠçà ñêåëåòí³, íåâðî-
ëîã³÷í³, ì’ÿçîâ³ óðàæåííÿ àáî ïîðóøåííÿ á³îåíåð-
ãåòèêè. Ç ö³º¿ òî÷êè çîðó ðóõîâà àäàïòàö³ÿ º íå
ëèøå ôîðìîþ ðóõîâîãî íàâ÷àííÿ, çàâäÿêè ÿê³é
íåðâîâà ñèñòåìà íàâ÷àºòüñÿ ïðîãíîçóâàòè òà í³âå-
ëþâàòè âïëèâ íîâîãî ñåðåäîâèùà, à ñêîð³øå ïðî-
öåñ, ðîçðîáëåíèé äëÿ ìàêñèìàëüíîãî ï³äâèùåííÿ
âèêîíàííÿ â öüîìó ñåðåäîâèù³29. Öÿ òî÷êà çîðó
â³äïîâ³äຠÌÊÔ ç óðàõóâàííÿì óñ³õ êîíòåêñòóàëü-
íèõ ôàêòîð³â, ùî ç’ºäíóþòü ôàêòîðè ñåðåäîâèùà
òà ïåðñîíàëüí³ ôàêòîðè ç îáìåæåííÿì ôóíêö³îíó-
âàííÿ ïàö³ºíò³â. Ç îãëÿäó íà öå, áóëî á êîðèñíî
ðîçøèðèòè ñåíñ òåðì³íó «ðóõîâà àäàïòàö³ÿ», ÿêèé
ïîâèíåí âêëþ÷àòè ÿê íåðâîâó ñèñòåìó, òàê ³ ì’ÿ-
çîâî-ñêåëåòíó ñèñòåìó, ùî ù³ëüíî çâ’ÿçàí³ êîîïå-
ðàòèâíîþ âçàºìî䳺þ30.
Çàëó÷åí³ ìåõàí³çìè º ñêëàäíèìè, âèÿâëÿþ÷è
áàãàòî ïîâåä³íêîâèõ àáî êîìï’þòåðíèõ ìîäåëåé
ðóõîâîãî êîíòðîëþ òà ðóõîâî¿ àäàïòàö³¿31. Ö³ ìî-
äåë³ çàëó÷àþòü øèðîêèé ñïåêòð äèñöèïë³í, çîêðå-
ìà íåéðîíàóêè, ïñèõîëîã³þ, ðîáîòîòåõí³êó, ìàòå-
ìàòèêó àáî êîìï’þòåðí³ íàóêè. Òàê³ ìîäåë³
êîðèñí³ äëÿ ðîçóì³ííÿ ðóõîâî¿ ïîâåä³íêè â êîìï’þ-
òåðíèõ óìîâàõ, àëå âîíè ìåíø óñï³øí³, êîëè âðà-
õîâóºòüñÿ çâ’ÿçîê ì³æ êîìï’þòåðíèìè òà íåéðî-
á³îëîã³÷íèìè ìîäåëÿìè, àáî êîëè âîíè
çàñòîñîâóþòüñÿ äî ôóíêö³îíàëüíèõ òà ïàòîëîã³÷-
íèõ àñïåêò³â32. Îäíàê, ìè ìîæåìî ï³äêðåñëèòè ðîëü
ïëàñòè÷íîñò³ â ðóõîâ³é ôóíêö³¿. ßêùî öå ïîâ’ÿçà-
íî ç íåéðîïëàñòè÷í³ñòþ, îñîáëèâî â ñèíàïòè÷í³é
ôóíêö³¿33, ìè ïîâèíí³ ïàì’ÿòàòè, ùî ïëàñòè÷í³ñòü
º çàãàëüíîþ á³îëîã³÷íîþ âëàñòèâ³ñòþ, ùî ñòî-
ñóºòüñÿ òàêîæ é ÷èííèêà âïëèâó, ç ¿¿ ð³çíèìè êîí-
ñòðóêö³ÿìè òêàíèí, ê³ñòîê, ñóãëîá³â òà ñêåëåòíèõ
ì’ÿç³â.
Ïëàñòè÷í³ñòü ñêåëåòíèõ ì’ÿç³â äîáðå çðîçóì³-
ëà, âîíà â³äïîâ³äຠçà ïåâí³ ñòàíè, ÿê³ âèíèêàþòü
âíàñë³äîê ô³çè÷íîãî òðåíóâàííÿ, ³ çà âòðàòó öèõ
101
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ñòàí³â, ùî ç’ÿâëÿºòüñÿ ï³ä ÷àñ õðîí³÷íî¿ çíåðóõîì-
ëåíîñò³ àáî ãîëîäó. Ö³ ñòàíè º ÷àñòèìè ó ïàö³ºíò³â
ç íåâðîëîã³÷íèìè, ñåðöåâî-ñóäèííèìè, äèõàëüíè-
ìè àáî íèðêîâèìè çàõâîðþâàííÿìè. ²íîä³ ¿õ íåçà-
ëåæí³ñòü ñåðéîçíî ïîðóøåíà. Ïðîòå, âèêîðèñòîâó-
þ÷è äåÿê³ ïðîãðàìè àêòèâ³çàö³¿ âèòðèâàëîñò³,
ìîæíà “ìàêñèìàëüíî çá³ëüøèòè” ¿õ ðóõîâå âèêî-
íàííÿ, óíèêàþ÷è âàæêî¿ çàëåæíîñò³34.
Ðóõîâ³ ñòðàòå㳿
Äëÿ äîñÿãíåííÿ ïåâíî¿ ìåòè ìè ìîæåìî âèêî-
ðèñòîâóâàòè á³ëüøå, í³æ îäèí ðóõîâèé ïëàí. Òåî-
ðåòè÷íî ³ñíóº âåëèêà ê³ëüê³ñòü ð³øåíü, á³ëüø-ìåíø
åíåðãåòè÷íî åêîíîì³÷íèõ ³ ìåõàí³÷íî åôåêòèâíèõ,
àëå ñåðåä óñ³õ öèõ ðóõîâèõ ñòðàòåã³é ïðàêòè÷íî ìè
îáèðàºìî íàéêðàùó. Òàêå âì³ííÿ çàëåæèòü â³ä
ðóõîâîãî ðîçâèòêó òà â³ä ðóõîâîãî íàâ÷àííÿ, ùî
ïîñòóïîâî ïðèçâîäèòü äî ïîáóäîâè âíóòð³øí³õ
ìîäåëåé, ÿê³ ïåðåäáà÷àþòü ñåíñîðí³ íàñë³äêè ðó-
õîâèõ êîìàíä. Âíàñë³äîê ³íäèâ³äóàëüíèõ ìîðôîëî-
ã³÷íèõ òà ð³çíèõ á³îëîã³÷íèõ õàðàêòåðèñòèê, ö³ ìî-
äåë³ º ñïåöèô³÷íèìè äëÿ îäí³º¿ ëþäèíè, ³ ³íîä³ âîíè
ìîæóòü áóòè äóæå íåçâè÷àéíèìè. Taylor ï³äãîòó-
âàâ îãëÿä ùîäî ðîë³ ñòðàòåã³é ðóõîâîãî íàâ÷àííÿ
íà Fosbury Flop, ùî ïðèçâåëî äî âèñîêîãî ñòðèá-
êà, ùî çì³íèâ ³ííîâàö³éíó ïàðàäèãìó35. Öåé ïðèêëàä
ï³äêðåñëþº â³äíîñí³ñòü ïîíÿòòÿ “íîðìà”. Á³ëüø
òîãî, ó ñôåð³ ÔÐÌ ïàö³ºíòè ðîçâèâàþòü íàâ÷àííÿ,
ÿêå õàðàêòåðèçóºòüñÿ ïðîöåñîì ïîâòîðíî¿ îïòèì³-
çàö³¿ ç óðàõóâàííÿì íîâèõ óìîâ, ùî âèíèêàþòü
âíàñë³äîê ïîðóøåíü. Íà öüîìó åòàï³ íåîáõ³äíî
âèñóíóòè ³äåþ ïðî òå, ùî ðåàá³ë³òàö³ÿ íå ïîâèííà
áóòè “îñîáëèâèì ³äåàëîì çäîðîâ’ÿ ÷è âèêîíàííÿ,
ÿê³ âèçíà÷åí³ çîâí³øíüî” ìåäè÷íîþ êîìàíäîþ36.
Îñíîâí³ ïðîöåñè, ùî ïðÿìóþòü äî ôóíêö³îíàëü-
íîãî íåéðîíàëüíîãî ïðåäñòàâíèöòâà, òàê çâàí³
âíóòð³øí³ ìîäåë³, ï³äòðèìóþòü íîâèé ï³äõ³ä ó ðå-
àá³ë³òàö³¿ ïàö³ºíò³â ç ãåì³ïëå㳺þ: á³ëàòåðàëüíå
ïåðåíåñåííÿ37. Ó ïàö³ºíò³â ³ç ï³äãîñòðèì ³íñóëüòîì
ìîæå ñïîñòåð³ãàòèñÿ ôóíêö³îíàëüíå ïîêðàùåííÿ
óðàæåíî¿ ðóêè çà äîïîìîãîþ òðåíóâàíü, ùî ïðîâî-
äÿòüñÿ ç³ çäîðîâîþ ðóêîþ. Ïðîöåñè, ùî äîëó÷åí³
äî öüîãî ñåíñîìîòîðíîãî íàâ÷àííÿ, íå º ÷³òêî â³äî-
ìèìè, àëå öå ôîðìóº âàæëèâ³ ïåðñïåêòèâè äëÿ
ñïåö³àëüíîñò³ ÔÐÌ.
Ñåíñîìîòîðíà àäàïòàö³ÿ
Ðóõîâà àäàïòàö³ÿ ìîæå áóòè ³íäóêîâàíà ó
â³äïîâ³äü íà çîâí³øíº ïîøêîäæåííÿ ó âèãëÿä³ ñåí-
ñîðíîãî êîíôë³êòó, âèêëèêàíîãî ïðèçìàòè÷íèìè
ë³íçàìè, ùî ñòâîðþþòü çñóâ â³çóàëüíîãî ñåðåäî-
âèùà (Ìàëþíîê 1À). Öÿ ñåíñîìîòîðíà àäàïòàö³ÿ
ôîðìóºòüñÿ ï³ñëÿ ïîâòîðíèõ øâèäêèõ âêàç³âíèõ
ðóõ³â ó á³ê â³çóàëüíèõ ö³ëåé. ¯õ ïåðâèííèé çñóâ â á³ê
îïòè÷íîãî â³äõèëåííÿ òà äî â³ðòóàëüíî¿ ö³ë³ ïîñòó-
102 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ïîâî çìåíøóâàâñÿ, ùî â³äîáðàæຠçäàòí³ñòü ðóõî-
âî¿ ñèñòåìè âðàõîâóâàòè ïðîñòîðîâó ïîìèëêó âíàñ-
ë³äîê ïðèçìàòè÷íîãî â³äõèëåííÿ. Ïðîïð³îöåïòèâ-
íà ïåðåáóäîâà â³äïîâ³äຠçà çì³ùåííÿ â³ä÷óòòÿ
ïîëîæåííÿ ðóêè ó íàïðÿìêó îïòè÷íîãî â³äõèëåííÿ.
Öå â³äïîâ³äຠçà ïðîïð³îöåïòèâíó îö³íêó óÿâëåííÿ
“âïåðåä” (íàïð. âêàçàòè ñàã³òàëüíó â³ñü) ó íàïðÿì-
êó, ïðîòèëåæíîìó îïòè÷íîìó â³äõèëåííþ ï³ñëÿ
âèäàëåííÿ ïðèçìè. ³çóàëüíà ïåðåáóäîâà, ùî
â³äïîâ³äຠçà çì³ùåííÿ â³ä÷óòòÿ íàïðÿìêó ïîãëÿ-
äó â á³ê, ïðîòèëåæíèé îïòè÷íîìó â³äõèëåííþ. Âîíà
â³äïîâ³äຠçà â³çóàëüíó îö³íêó óÿâëåííÿ “âïåðåä”
â íàïðÿìêó îïòè÷íîãî â³äõèëåííÿ ï³ñëÿ âèäàëåííÿ
ïðèçìè38. Ìàòåìàòè÷íà ñóìà ïðîïð³îöåïòèâíî¿ òà
â³çóàëüíî¿ ïåðåáóäîâè áóëà ð³âíîþ çàãàëüí³é ïåðå-
áóäîâ³ â êîîðäèíàö³¿ “îêî-ðóêà”, ùî âèì³ðþâàëàñü,
âêàçóþ÷è íà â³çóàëüíó ö³ëü, áåç çâîðîòíîãî â³çó-
àëüíîãî çâ’ÿçêó àáî çíàíü ïðî ðåçóëüòàòè39.
Îá³çíàí³ñòü ïðî âèÿâëåííÿ/êîðèãóâàííÿ ïîõè-
áîê âêàçóâàííÿ ï³ä ÷àñ âèêîðèñòàííÿ ïðèçìè íå º
íåîáõ³äíîþ äëÿ ñåíñîìîòîðíî¿ ïåðåáóäîâè. Åêñ-
ïåðèìåíòàëüí³ ïðîöåäóðè, ùî âèêîðèñòîâóþòü
îïòè÷í³ çì³ùåííÿ, ùî çá³ëüøóþòüñÿ, äîçâîëÿþòü
çä³éñíèòè çíà÷íó ïåðåáóäîâó, â³ëüíó â³ä âïëèâó
íàâìèñíî¿ êîðåêö³¿40,41. Ïîä³áíèì ÷èíîì, ïàö³ºíòè
ç íåãëåêòîì íå âèÿâëÿþòü â³çóàëüíèõ ïîðóøåíü ï³ä
÷àñ âèêîðèñòàííÿ ïðèçìè, ùî äåìîíñòðóº ñóòòºâ³
òà äîâãîòðèâàë³ íàñë³äêè38,42. Àäàïòàö³ÿ ìîæå ðîç-
âèâàòèñÿ íàâ³òü ï³ä ÷àñ óÿâíèõ âêàç³âíèõ ðóõ³â (áåç
ôàêòè÷íîãî âèêîíàííÿ) ï³ä ÷àñ âèêîðèñòàííÿ ïðè-
çìè. Òîìó, êîëè ïðèñóòí³ ìîæëèâ³ ñåíñîðí³ ïðîñòî-
ðîâ³ ðîçá³æíîñò³ ðîçòàøóâàííÿ ðóêè (â³çóàëüíå
ðîçòàøóâàííÿ ç³ çñóâîì ïðîòè ïðîïðèîöåïòèâíîãî
“íåçì³ùåíîãî” ðîçòàøóâàííÿ), ðóõîâà ï³äãîòîâêà
º äîñòàòíüîþ äëÿ ñïîíóêàííÿ ïåðåáóäîâè43.
Ñåíñîìîòîðíà àäàïòàö³ÿ
òà êîãí³òèâíà åêñïàíñ³ÿ
Ö³êàâî, ùî öÿ â³çóàëüíî-ðóõîâà àäàïòàö³ÿ, âèê-
ëèêàíà âèêîðèñòàííÿì ïðèçìè, ìîæå âçàºìîä³ÿòè
ç âèùèìè êîðêîâèìè ôóíêö³ÿìè, ÿê³ ïîâ’ÿçàí³ ç
ìóëüòèñåíñîðíîþ ³íòåãðàö³ºþ, é öå ï³äòâåðäæåíî
âðàæàþ÷èìè ðåçóëüòàòàìè, ïðî ÿê³ ïîâ³äîìëÿëîñü
ïðè ë³âîá³÷íîìó óí³ëàòåðàëüíîìó íåãëåêò³ ï³ñëÿ
ïðàâîá³÷íîãî îïòè÷íîãî â³äõèëåííÿ ïîëÿ çîðó ó
ïàö³ºíò³â ç ïîøêîäæåííÿì ïðàâî¿ ï³âêóë³ ìîçêó44
(Ìàëþíîê 1Â). Öå ïîë³ïøåííÿ âïëèâຠíà ïåâí³
ñèìïòîìè, ÿê³ â³ëüí³ â³ä ìàíóàëüíèõ â³äïîâ³äåé
(ñëóõîâèé íåãëåêò, ïðåäñòàâíèöüêèé íåãëåêò) òà
³íøèõ ïîðóøåíü, ÿê³ íå º íåãëåêòîì, òàêèõ ÿê
ïîðóøåííÿ êîíñòðóþâàííÿ, íàâ³ãàö³¿ òà íàâ³òü
çìåíøåííÿ ñêëàäíîãî ðåã³îíàëüíîãî êîìïëåêñíî-
ãî áîëüîâîãî ñèíäðîìó, ùî ïåðåäáà÷àº, òàêèì
÷èíîì, ðîçøèðåííÿ ñåíñîìîòîðíèõ íàñë³äê³â ïðî-
ñòîðîâîãî ï³çíàííÿ øëÿõîì çíèçó ââåðõ38,45.
¹2(2) *2018
 
ÐÎÇÄ²Ë 6 – ÇÍÀÍÍß ÒÀ ÍÀÂÈ×ÊÈ Ë²ÊÀв ÔÐÌ

Ìàëþíîê 1. – Ïðèçìàòè÷íà àäàïòàö³ÿ. Ôàçè ïðèçìàòè÷íî¿ àäàïòàö³¿ (A): îñîáà íàäÿãຠîêóëÿðè ç ïðèçìàòè÷íèìè ë³íçàìè,
ùî ñòâîðþþòü îïòè÷íèé çñóâ âïðàâî íà 10° (ïðå-òåñò). ϳä ï³äáîð³ääÿì îñîáè ðîçì³ùóºòüñÿ ïîëèöÿ, ùî íå äîçâîëÿº äèâèòèñü
íà ðóêó â ¿¿ ïî÷àòêîâîìó ïîëîæåíí³, àëå äîçâîëÿº áåçïåðåøêîäíî äèâèòèñü íà ö³ë³ ³ ê³íöåâ³ âêàç³âí³ ïîìèëêè (ñóïðåñ³ÿ ïðÿìîãî
â³çóàëüíîãî çâ’ÿçêó ç ðóõîì). Íà ïî÷àòêó ïðîöåñó îñîá³ ïðîïîíóºòüñÿ çðîáèòè øâèäê³ âêàç³âí³ ðóõè (ñóïðåñ³ÿ çâîðîòíîãî â³çóàëü-
íîãî çâ’ÿçêó ç ðóõîì) ó íàïðÿìêó â³çóàëüíî¿ ö³ë³ (åêñïîçèö³ÿ).
Âêàç³âí³ ðóõè çì³ùóþòüñÿ â á³ê îïòè÷íîãî â³äõèëåííÿ (÷îðíà ñòð³ëêà) òà äî â³ðòóàëüíî¿ ö³ë³ (ïåðâèíí³ ïîìèëêè). Ðóõîâà ñèñòå-
ìà ïîò³ì ìîæå âðàõóâàòè ïðîñòîðîâó ïîõèáêó âíàñë³äîê â³äõèëåííÿ ïðèçìè (àäàïòàö³ÿ), íåçàëåæíî â³ä òîãî, ÷è äåìîíñòðóº
îñîáà ôåíîìåíîëîã³÷íå óÿâëåííÿ ïðî ïîõèáêó ³, íàðåøò³, êîìïåíñóº îïòè÷íå â³äõèëåííÿ (êîìïåíñàö³ÿ).
ϳñëÿ âèäàëåííÿ ïðèçìàòè÷íèõ îêóëÿð³â, êîëè îñîá³ ïðîïîíóºòüñÿ ùå ðàç øâèäêî âêàçóâàòè íà ö³ëü, ðóõ çì³ùóºòüñÿ â íàïðÿìêó,
ïðîòèëåæíîìó îïòè÷íîìó â³äõèëåííþ (âë³âî: ÷åðâîíà ñòð³ëêà) (ï³ñëÿä³ÿ). ³äïîâ³äíèì àðãóìåíòîì äëÿ ðåàá³ë³òàö³¿ íåãëåêòó º
òå, ùî ï³ñëÿ ïðàâîá³÷íîãî îïòè÷íîãî â³äõèëåííÿ ïîëÿ çîðó, îñîáè òàêèì ÷èíîì äåìîíñòðóþòü ñèñòåìàòè÷íå â³äõèëåííÿ âë³âî
â³çóàëüíî – ìîòîðíèõ â³äïîâ³äåé àäàïòîâàíîþ ê³íö³âêîþ áåç çàëó÷åííÿ äîâ³ëüíî¿ óâàãè ïàö³ºíòà, íàïðèêëàä â³äïîâ³äíî ïî â³äñòå-
æåííÿ çíèçó- âãîðó.
Ïîë³ïøåííÿ ïîðóøåíü ïðîñòîðîâî – ï³çíàâàëüíî¿ çäàòíîñò³ ï³ñëÿ ïðèçìàòè÷íî¿ àäàïòàö³¿ ó ïàö³ºíò³â ç ïîøêîäæåííÿì ïðàâî¿
ï³âêóë³ ãîëîâíîãî ìîçêó (Â): çîðîâèé íåãëåêò ïðè âèêîíàíí³ çàâäàíü íàìàëþâàòè ç ïàì’ÿò³ ðîìàøêó (1) ³ øëÿõîì êîï³þâàííÿ (2);
îáðàçíèé íåãëåêò, ùî îö³íþºòüñÿ â³äíîâëåííÿì ïî ïàì’ÿò³ ìàïè Ôðàíö³¿ (3); ñëóõîâèé íåãëåêò, ùî îö³íþºòüñÿ çà äîïîìîãîþ
çàâäàííÿ íà ñëóõàííÿ (4); íàâ³ãàö³ÿ íà â³çêó (5) òà ïðîñòîðîâà äèñãðàô³ÿ (6).

Äçåðêàëüí³ åôåêòè, íàïð. ñèìóëÿö³ÿ íåãëåêòó,
òàêîæ ñïîñòåð³ãàºòüñÿ ïðè áàãàòüîõ êîãí³òèâíèõ
ôóíêö³ÿõ ó çäîðîâèõ ëþäåé ï³ñëÿ àäàïòàö³¿ ç âèêî-
ðèñòàííÿì ïðèçìè. Ñèìóëÿö³ÿ íåãëåêòó áóëà îïè-
ñàíà íå ëèøå ó ïðåäñòàâíèöòâ³ íàâêîëîîñîáèñò³ñ-
íîãî, ïîçàîñîáèñò³ñíîãî òà ò³ëåñíîãî ïðîñòîðó, àëå
³ ïðè âèêîðèñòàíí³ öèôðîâèõ òà áóêâåíèõ ïñèõîìåò-
ðè÷íèõ øêàë. Âïëèâ àäàïòàö³¿ ç âèêîðèñòàííÿì ïðè-
çìè ïîøèðþºòüñÿ òàêîæ íà ïðîñòîðîâó óâàãó, ³ºðàð-
õ³÷íó îáðîáêó òà ïðîñòîðîâå ïåðåì³øóâàííÿ 46.
Òåðì³í “êîãí³òèâíèé”, ÿêèé âèêîðèñòîâóºòüñÿ äëÿ
îïèñàííÿ íàñë³äê³â, âêàçóº íà òîé ôàêò, ùî åôåêòè
âèíèêàþòü çà ìåæàìè çâè÷àéíî¿ ñèñòåìè êîìïåí-
ñàòîðíèõ ñåíñîìîòîðíèõ íàñë³äê³â òà âêëþ÷àþòü
ïñèõ³÷í³ çä³áíîñò³, òàê³ ÿê ñóäæåííÿ, ïîð³âíÿííÿ àáî
ïñèõ³÷íå ïðåäñòàâíèöòâî ïðîñòîðó. Ïîÿâà êîãí³òèâ-
íèõ íàñë³äê³â íàâ³òü á³ëüø ö³êàâ³øà, ÿêùî âðàõó-
âàòè, ùî ¿õ íå ìîæíà ïîÿñíèòè ñåíñîìîòîðíèìè íà-
ñë³äêàìè, àëå âîíè ïîâí³ñòþ çàëåæàòü â³ä
ïðîñòîðîâî¿ ïåðåáóäîâè. Á³ëüø òîãî, ïðîñòîðîâà
ïåðåáóäîâà ïîâèííà áóòè äîñòàòíüî ñèëüíîþ (âè-
êîðèñòîâóþ÷è ïðèíàéìí³ 10° îïòè÷íå â³äõèëåííÿ
ÿê ó ïàö³ºíò³â ç íåãëåêòîì, òàê ³ ó çäîðîâèõ îñ³á)
äëÿ îòðèìàííÿ êîãí³òèâíèõ íàñë³äê³â45,46.
²íø³ ìåõàí³çìè àäàïòàö³¿
Îêð³ì ïðÿìèõ íåéðîô³ç³îëîã³÷íèõ àäàïòàö³é, ùî
ðîçãëÿäàþòüñÿ äîòåïåð, º àäàïòàö³¿, ÿê³ ìîæíà ââà-
æàòè “çîâí³øí³ìè” â³äíîñíî äî àíàòîì³÷íî¿ ëîêàë³-
çàö³¿ ïåðâèííîãî óðàæåííÿ òà/àáî íàâ³òü çîâí³øí³ìè

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 103
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
äëÿ îñîáè, ùî ðîçãëÿäàºòüñÿ. Ïåðøà âêëþ÷ຠâ
ñåáå âèêîðèñòàííÿ ³íøèõ ñòðóêòóð òà ôóíêö³é îðãà-
í³çìó äëÿ çàì³íè ïîøêîäæåíî¿; îñòàííÿ – çàñòîñó-
âàííÿ ïðîòåçó/îðòåçó äëÿ êîìïåíñàö³¿ âòðàòè
ôóíêö³¿.  îáîõ âèïàäêàõ äëÿ îïòèì³çàö³¿ àäàïòàö³¿
òà äîñÿãíåííÿ íàéêðàùèõ ìîæëèâèõ ôóíêö³îíàëü-
íèõ ðåçóëüòàò³â íåîáõ³äíèì º ãàðíèé ï³äõ³ä ô³çè÷-
íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè òà ïðîöåñ íàâ÷àí-
íÿ, âêëþ÷àþ÷è ³íôîðìóâàííÿ, îñâ³òó òà âïðàâè.
Àäàïòàö³ÿ, àá³ë³òàö³ÿ òà ðåàá³ë³òàö³ÿ
Ïðîöåñè àäàïòàö³¿ òà, â ïåðøó ÷åðãó, ðóõîâà
àäàïòàö³ÿ º âàæëèâèìè â ô³çè÷í³é òà ðåàá³ë³òàö³éí³é
ìåäèöèí³. Ðóõîâà àäàïòàö³ÿ âêëþ÷ຠñåíñîìîòîðí³
âçàºìî䳿, ùî âèìàãàþòüñÿ ó â³äïîâ³äü íà çîâí³øí³
çì³íè àáî çì³íè â îðãàí³çì³, ³ ñïèðàþòüñÿ íà ïðàê-
òèêó ïîâòîðíèõ âïðàâ ïðîòÿãîì êîðîòêîãî ÷àñó.
Àäàïòàö³ÿ çäîáóâàºòüñÿ øëÿõîì íåÿâíîãî íàâ÷àí-
íÿ áåç îá³çíàíîñò³ ñóá’ºêòó, ùî ðîáèòü éîãî ïðî-
ñòèì ìåòîäîì ó ïàö³ºíò³â ç ïîøêîäæåííÿì ìîçêó
òà ïîðóøåííÿìè óâàãè. Öå âêëþ÷ຠäîâãîòðèâàë³
ñåíñîìîòîðí³ íàñë³äêè, àëå òàêîæ é êîãí³òèâí³ íà-
ñë³äêè, ÿê³, òàêèì ÷èíîì, äåìîíñòðóþòü, ùî ñåí-
ñîìîòîðí³ âçàºìî䳿 ìîæóòü âïëèâàòè íà êîãí³òèâí³
ïðîöåñè ÷åðåç øëÿõ çíèçó-ââåðõ. Õàðàêòåðèñòèêè
àäàïòàö³¿ òà ¿¿ êîðèñíèõ âïëèâ³â ïîâèíí³ ñïðèÿòè
á³ëüø øèðîêîìó âèêîðèñòàííþ â ô³çè÷í³é òà ðåà-
á³ë³òàö³éí³é ìåäèöèí³ ìåòîä³â ðåàá³ë³òàö³¿ íà îñíîâ³
àäàïòàö³¿.
Íàâ³òü ÿêùî âîíè âèêîðèñòîâóþòüñÿ îäíàêîâî,
ö³ íåéðîô³ç³îëîã³÷í³ ïðîöåñè â³ä³ãðàþòü ³íøó ðîëü
ó ðåàá³ë³òàö³¿ (ïåðåâàæíî ïîâ’ÿçàíîþ ç äîðîñëèìè)
òà â àá³ë³òàö³¿ (ïðîòÿãîì çðîñòàííÿ).  ïåðøîìó
âèïàäêó, ìåòîþ º â³äíîâëåííÿ íàéêðàùî¿ ìîæëè-
âî¿ ó÷àñò³ â ðàìêàõ ÷àñòêîâî¿ àáî ïîâíî¿ ñòðóêòóð-
íî¿ âòðàòè, â äðóãîìó – çàïîá³ãàííÿ íåãàòèâíîìó
âïëèâó íà ðîçâèòîê ³íòàêòíèõ ñòðóêòóð / ôóíêö³é
îðãàí³çìó çà ðàõóíîê ïåðâèííî óðàæåíèõ, ç âèíèê-
íåííÿì âòîðèííèõ ïîðóøåíü, çáåð³ãàþ÷è äîñÿãíåí-
íÿ íàéêðàùî¿ ìîæëèâî¿ àêòèâíîñò³ òà, íàðåøò³,
ó÷àñò³. ϳä ÷àñ àá³ë³òàö³¿, çðîñòàííÿ ìîæå ââàæà-
òèñÿ ðóø³éíîþ ñèëîþ, ùî ïðèçâîäèòü äî “ïðèðîä-
íèõ”, ³íîä³ íååôåêòèâíèõ àáî íàâ³òü øê³äëèâèõ
êîìïåíñàö³é; àëå çðîñòàííÿ òàêîæ ìîæå áóòè âå-
ëèêîþ ñèëîþ, ÿêà, ÿêùî äîáðå êåðóâàòè ÷åðåç
ïðàâèëüí³ ïðîöåñè àäàïòàö³¿, ìîæå â÷àñíî ïðèçâå-
ñòè äî ãàðíèõ êîìïåíñàö³é, ùî ïðîäóêóþòü êðàùå
ôóíêö³îíóâàííÿ, í³æ î÷³êóâàëîñÿ çà ïðèðîäíîþ
³ñòîð³ºþ ïåðâèííîãî çàõâîðþâàííÿ.
Îö³íêà ïîòåíö³àëó â³äíîâëåííÿ òà ïðîãíîç
â ô³çè÷í³é òà ðåàá³ë³òàö³éí³é ìåäèöèí³
Ôóíêö³îíàëüíå â³äíîâëåííÿ – öå ìåòà ïåðñîíè
ï³ñëÿ âèíèêíåííÿ õâîðîáè, òðàâìè àáî ³íøîãî ñòà-
104 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
íó çäîðîâ’ÿ (íàïð. ñòàð³ííÿ), òà ïîøóê ðåàá³ë³òà-
ö³éíîãî âòðó÷àííÿ – öå çàñ³á äëÿ äîñÿãíåííÿ íàé-
êðàùîãî ìîæëèâîãî ôóíêö³îíóâàííÿ. ˳êàð ÔÐÌ
íàâ÷àºòüñÿ áà÷èòè ïàö³ºíòà íå ÿê ãðóïó îðãàí³â òà
ñèñòåì ç ïåâíîþ çáåðåæåíîþ ôóíêö³ºþ ÷è ñòðóê-
òóðîþ, àëå â ö³ëîìó ç ïåâíèì ð³âíåì ôóíêö³î-
íóâàííÿ.
Ðåàá³ë³òàö³éíèé ïëàí ïîâèíåí ïî÷èíàòèñÿ ç âèç-
íà÷åííÿ ð³âíÿ ïðåìîðá³äíîãî ôóíêö³îíóâàííÿ, àëå
òàêîæ ïîâèíåí ïî÷èíàòèñÿ ç óÿâëåííÿ ô³íàëüíîãî
ôóíêö³îíóâàííÿ. Ñïîñòåðåæí³ äîñë³äæåííÿ ïðî
³ñòîð³þ ðîçâèòêó çàõâîðþâàíü ïîêàçàëè, ùî êðèâ³
â³äíîâëåííÿ íå â³äïîâ³äàþòü ë³í³éíîìó ïðîöåñó,
àëå â îñíîâíîìó ïðîõîäÿòü ÷åðåç ïåðøó ôàçó ç³
øâèäêèì â³äíîâëåííÿì ³ äðóãó ôàçó ç á³ëüø ïî-
â³ëüíèì ïîë³ïøåííÿì ðóõîâî¿ ôóíêö³¿, àáî ð³äøå,
ñòóïåíÿìè òà ïëàòî. Òðèâàë³ñòü ïåðøî¿ ôàçè
â³äð³çíÿºòüñÿ äëÿ ð³çíèõ ïàòîëîã³é ³ âîíà ââàæàºòü-
ñÿ íàéâàæëèâ³øîþ äëÿ ðåàá³ë³òàö³¿: á³ëüø³ñòü çó-
ñèëü ÔÐÌ ìàþòü çîñåðåäæóâàòèñÿ íà öüîìó åòàï³
(ï³äãîñòðà ðåàá³ë³òàö³ÿ), ùîá ï³äâèùèòè ÿê³ñòü òà
ê³ëüê³ñòü â³äíîâëåííÿ.
Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà çîñåðåäæå-
íà íà ëþäèí³, çà ìåæàìè õâîðîáè, ïðîòå ïðîãíîç
ëèøå ÷àñòêîâî ´ðóíòóºòüñÿ íà ïðèðîäí³é ³ñòîð³¿
ðîçâèòêó ïåðâèííîãî çàõâîðþâàííÿ. Ç îäíîãî áîêó,
ñë³ä âðàõîâóâàòè ñóïóòí³ çàõâîðþâàííÿ, à ç ³íøî-
ãî – îñîáèñò³ ôàêòîðè òà ôàêòîðè ñåðåäîâèùà, ÿê
áàð’ºðè òà/àáî ÷èííèêè, ñïðèÿòëèâ³ äëÿ â³äíîâëåí-
íÿ. Á³ëüø òîãî, ³íäèâ³äóàëüí³ ö³ë³ ó÷àñò³ ïîòðåáó-
þòü âåëèêî¿ óâàãè òà ñïðèÿþòü âèçíà÷åííþ îñòà-
òî÷íîãî ïðîãíîçó òà âñ³º¿ ïðîãðàìè ðåàá³ë³òàö³¿.
Íåçâàæàþ÷è íà öå, â ÷àñè ñêîðî÷åííÿ ðåñóðñ³â,
îáîâ’ÿçêîâèì º âñòàíîâëåííÿ â³äïîâ³äíèõ ö³ëåé
äëÿ êîæíîãî ïàö³ºíòà â³äïîâ³äíî äî ïðîãíîçó, ÿêèé
ïîâ’ÿçàíèé ³ç çàõâîðþâàííÿì, òà ³íøèõ ïîíÿòü “ðå-
àá³ë³òàö³éíîãî ïîòåíö³àëó”: ÷è çìîæå ïàö³ºíò ïîë³-
ïøèòè ñâ³é ñòàí äî êðàùîãî ôóíêö³îíàëüíîãî ñòà-
íó? ×è çìîæå ðåàá³ë³òàö³éíå âòðó÷àííÿ ðåàëüíî
çì³íèòè ó÷àñòü ïàö³ºíòà?  ÷èñò³é ìîäåë³ “ñï³â÷óò-
òÿ” ó ðåàá³ë³òàö³¿ í³êîìó íå â³äìîâëÿþòü; ó âèêëþ÷-
íî “õâîðîáî-öåíòðè÷í³é” ìîäåë³, ðåàá³ë³òàö³ÿ íå
íàäàºòüñÿ, îñê³ëüêè ââàæàºòüñÿ, ùî ïàö³ºíò çäàò-
íèé ñïîíòàííî â³äíîâèòèñü áåç áóäü-ÿêèõ âòðó÷àíü,
ÿê ò³ëüêè õâîðîáà áóäå ë³êóâàòèñÿ. Çà ñó÷àñíîãî
ï³äõîäó, ïðîòå, ðåàá³ë³òàö³ÿ ïîâèííà áóòè íàäàíà
ïàö³ºíòàì, ÿê³ ä³éñíî çäàòí³ ïîë³ïøèòè ñòàí çäîðî-
â’ÿ ïðîòÿãîì ïåâíîãî ÷àñîâîãî ïðîì³æêó ñòàíó
çäîðîâ’ÿ ç ïî÷àòêîì ³ çàê³í÷åííÿì âòðó÷àííÿ (çà
íèì ñë³äóº ï³äòðèìêà, ÿêà òàêîæ íàçèâàºòüñÿ ïîñò-
ðåàá³ë³òàö³ºþ).
Îñîáëèâî ñïåöèô³÷íèì äëÿ ô³çè÷íî¿ òà ðåàá³ë³-
òàö³éíî¿ ìåäèöèíè º ïðîáëåìà ñï³ëêóâàííÿ ç ïàö³-
ºíòîì ùîäî î÷³êóâàíü (ïðîãíîçó) âíàñë³äîê ìåäè÷-
íèõ ôàêòîð³â, ÿêå íå ïðîâîäèòüñÿ ïðè áàãàòüîõ
¹2(2) *2018

çàõâîðþâàííÿõ, ùî ïðèçâîäÿòü äî îáìåæåíü æèò-
òºä³ÿëüíîñò³, ìåäè÷íèì ñïåö³àë³ñòîì, ÿêèé ë³êóº ó
ãîñòð³é ôàç³. Ñàìå öå º îäí³ºþ ç ñóòòºâèõ ïðîáëåì
ó ðåàá³ë³òàö³¿, îñîáëèâî çàðàç, êîëè ìåäè÷íèé òà
íàóêîâèé ðîçâèòîê âïëèâຠíà ñóñï³ëüñòâî, ÿêå
ââàæàº, ùî “âñå ìîæëèâî”: òàêèì ÷èíîì, íàãîëîñ
ìຠáóòè íà äîñÿãíåíí³ êîíñåíñóñó ùîäî ö³ëåé
ðåàá³ë³òàö³¿, óçãîäæåíîãî ïàö³ºíòîì / ïîñåðåäíèêîì
³ ìåäè÷íîþ êîìàíäîþ47. ˳êàð ÔÐÌ ïîâèíåí áóòè
ïî³íôîðìîâàíèé ïðî õâîðîáè, ùî ñïðè÷èíÿþòü
îáìåæåííÿ æèòòºä³ÿëüíîñò³, äëÿ îòðèìàííÿ á³ëüø
äåòàëüíî¿ ³íôîðìàö³¿ ùîäî ïðîãíîçó, àëå, íåçâàæà-
þ÷è íà âñþ íàÿâíó ìåäè÷íó ³íôîðìàö³þ, ³ñíóþòü
ïåâí³ óìîâè (íàïð. ïàö³ºíòè ç ïîðóøåííÿìè ñâ³äî-
ìîñò³ ï³ñëÿ ÷åðåïíî-ìîçêîâèõ òðàâì), ïðîãíîç ÿêèõ
º íåâèçíà÷åíèì òà ïàö³ºíòè ³ ïîñåðåäíèêè, çàçâè-
÷àé, ìàþòü îïòèì³ñòè÷íå óïåðåäæåííÿ 48 ùîäî
ïðîãíîçó, ùî îçíà÷àº, ùî âîíè âèìàãàòèìóòü íå-
ðåàë³ñòè÷íèõ ö³ëåé òà âòðó÷àíü. Ó öüîìó ñåíñ³
íàâ÷àííÿ ë³êàðÿ ÔÐÌ ç êîìóí³êàö³éíèõ íàâè÷îê,
ðàçîì ç íàâè÷êàìè ë³äåðñòâà äîïîìîæóòü êðàùå
çðîçóì³òè ïëàíóâàííÿ ðåàá³ë³òàö³¿49.
˳êàð³ ÔÐÌ â³ä³ãðàþòü âàæëèâó ðîëü ó ðåàá³ë³-
òàö³éíîìó ïðîöåñ³, îñê³ëüêè âîíè íàâ÷àþòüñÿ ðîç-
âèòêó íàâè÷îê êåð³âíèöòâà ìóëüòè-ïðîôåñ³éíèìè
êîìàíäàìè, ò³ñíî ñï³âïðàöþþ÷è ç ³íøèìè äèñöèï-
ë³íàìè, òà ìàþ÷è çäàòí³ñòü ïðîâîäèòè ïîâíå îö³-
íþâàííÿ ñêëàäíîãî ôóíêö³îíàëüíîãî ñòàòóñó ïàö³-
ºíòà ³ ìîæëèâîñò³ çäîáóòòÿ ïåâíîãî ðåçóëüòàòó â
ìàéáóòíüîìó50. Âîíè òàêîæ ñòèêàþòüñÿ ç â³äïî-
â³äàëüí³ñòþ ùîäî íàäàííÿ çîáðàæåííÿ ïîòåíö³é-
íîãî çíà÷åííÿ ôóíêö³îíàëüíîãî ñòàòóñó äëÿ ïëà-
íóâàííÿ ìàéáóòí³õ ïîòðåá, âèçíà÷åííÿ ïîñëóã, ÿê³
áóäóòü íàäàí³, òà ðîçïîä³ëó ðåñóðñ³â äëÿ çàáåçïå-
÷åííÿ âòðó÷àíü.  òåïåð³øí³é ÷àñ, êîëè ìåäè÷í³
ðåñóðñè º îáìåæåíèìè, äóæå âàæëèâî íàäàòè
òî÷í³ íàóêîâ³ äîêàçè ùîäî ìåòîä³â ðåàá³ë³òàö³¿ òà
¿õ âïëèâó íà ïàö³ºíòà, éîãî ðîäèíó òà ñóñï³ëüñòâî.
Óïðàâë³íñüê³ íàâè÷êè
˳êàð³ ÔÐÌ â³äïîâ³äàëüí³ çà ñïðèÿííÿ çóñèëëÿì
ïàö³ºíò³â ùîäî äîñÿãíåííÿ ìàêñèìàëüíî îïòè-
ìàëüíîãî æèòòÿ ï³ñëÿ çàõâîðþâàííÿ àáî òðàâìè,
àáî ó ðîçâèòêó ïåâíî¿ îñîáè ç³ ñòàíîì çäîðîâ’ÿ.
Äëÿ òîãî, ùîá áóòè ãàðíèì ë³êàðåì ÔÐÌ, íåîáõ³äí³
â³äì³íí³ òåõí³÷í³, íàóêîâ³ òà óïðàâë³íñüê³ íàâè÷êè.
Ðîçâèòîê óïðàâë³íñüêèõ íàâè÷îê áóâ ÷àñòèíîþ
ìåäè÷íî¿ ï³äãîòîâêè ïðîòÿãîì îñòàíí³õ äâîõ äå-
ñÿòèë³òü, à â äåê³ëüêîõ äîñë³äæåííÿõ áóëî çàçíà-
÷åíî, ùî ñèñòåìè îõîðîíè çäîðîâ’ÿ, ÿê³ º êðàùå
êåðîâàíèìè, ñòâîðþþòü íå ëèøå ÿê³ñí³ ïîñëóãè
äëÿ ïàö³ºíò³â òà ï³äâèùåíó ïðîäóêòèâí³ñòü, àëå
òàêîæ çá³ëüøóþòü çàäîâîëåí³ñòü ïàö³ºíò³â òà ïåð-
ñîíàëó51.
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 6 – ÇÍÀÍÍß ÒÀ ÍÀÂÈ×ÊÈ Ë²ÊÀв ÔÐÌ
Òðàäèö³éíî, ÿê äåìîíñòðóþòü áàãàòî ñîö³îëî-
ã³÷íèõ äîñë³äæåíü, ë³êàð³ íåãàòèâíî ñòàâëÿòüñÿ äî
óïðàâë³íñüêèõ ïðàêòèê, ùî, éìîâ³ðíî, º ðåçóëüòà-
òîì òðàäèö³éíîãî ïàòåðíàë³ñòñüêîãî ï³äõîäó äî
ìåäè÷íî¿ ïðàêòèêè. Ìåäè÷íà îñâ³òà çîñåðåäæóâà-
ëàñü íà çá³ëüøåíí³ çíàíü ³ òðèâàëîñò³ íàâ÷àííÿ,
çàì³ñòü âèçíà÷åííÿ ïð³îðèòåòîì åôåêòèâíîñò³ òà
ÿêîñò³. Ïðîòÿãîì áàãàòüîõ ðîê³â â ³ñòî𳿠ìåäè÷-
íî¿ ïðàêòèêè ë³êàð³â âèêîðèñòîâóâàëè äëÿ ðîáîòè
â íåâåëèêèõ ³íäèâ³äóàëüíèõ êîíñóëüòàö³ÿõ àáî öåí-
òðàõ äëÿ êåð³âíèöòâà áåççàïåðå÷íîþ êîìàíäîþ ³
ïðàêòèêóâàííÿ áåç óðàõóâàííÿ âèòðàò òà ³íøèõ
åêîíîì³÷íèõ ÷èííèê³â.
 XXI ñòîë³òò³ öå çì³íèëîñÿ, òà ïåðåä ìåäèöè-
íîþ ïîñòຠðÿä ïðîáëåì, òàêèõ ÿê:
– Ïåðåõ³ä â³ä ïàòåðíàë³ñòñüêîãî ï³äõîäó äî
ïàö³ºíò-öåíòðè÷íîãî, â ÿêîìó ïðîôåñ³îíàë âè-
êîíóº ðîëü ïîñòà÷àëüíèêà ð³øåíü äëÿ ïðîáëåì
ïàö³ºíòà, ³ éîãî ñë³ä àäàïòóâàòè â³äïîâ³äíî äî
ìîðàëüíèõ ð³øåíü òà î÷³êóâàíü ïàö³ºíòà.
– Âèíèêíåííÿ íîâèõ òåñò³â, ìåòîä³â ë³êóâàííÿ,
ë³ê³â òà, çâè÷àéíî, çá³ëüøåííÿ òðèâàëîñò³ æèò-
òÿ òà á³ëüøîãî âïëèâó äåê³ëüêîõ äîâãîòðèâàëèõ
ñòàí³â ïåâíèõ çàõâîðþâàíü º ïðè÷èíîþ âåëè÷åç-
íèõ âèòðàò íà ìåäè÷í³ ïîñëóãè.
– Ô³íàíñîâ³ çàãðîçè äëÿ âèæèâàííÿ áàãàòüîõ ñè-
ñòåì îõîðîíè çäîðîâ’ÿ º íàñë³äêîì âèùåçàçíà-
÷åíî¿ ñèòóàö³¿, ³ º òåíäåíö³ÿ çîñåðåäæåííÿ íà
ïîë³ïøåíí³ îõîðîíè çäîðîâ’ÿ íå ò³ëüêè ç áîêó
ìåäè÷íèõ ðåçóëüòàò³â, àëå ó âèì³ðþâàíí³ ÿêîñò³
äîïîìîãè, ïðîçîðîñò³ òà åôåêòèâíîñò³52.
Ó ñôåð³ ðåàá³ë³òàö³¿ òàêà ñàìà êàðòèíà ñïîñòå-
ð³ãàºòüñÿ íàâ³òü ç äåÿêèìè ïàðàäèãìàëüíèìè
ì³ðêóâàííÿìè. ˳êàð³ ÔÐÌ ë³êóþòü ïàö³ºíò³â, ÿê³
÷àñòî ìàþòü óñêëàäíåí³ ñòàíè, òàê³, ÿê ñïîëó÷åíà
òðàâìà, ñï³íàëüíà òðàâìà, ÷åðåïíî-ìîçêîâà òðàâ-
ìà àáî õðîí³÷íèé á³ëü. Âîíè ïðàöþþòü, î÷îëþþ-
÷è ìóëüòè-ïðîôåñ³éí³ êîìàíäè, ÿê³ ïðàöþþòü
ñï³ëüíî, â ÿêèõ ãàðíà êîìóí³êàö³ÿ òà êîîðäèíàö³ÿ º
íåîäì³ííèìè äëÿ óñï³õó. Âîíè òàêîæ ìàþòü ñïðà-
âó ç âèñîêèìè î÷³êóâàííÿìè ùîäî â³äíîâëåííÿ ó
ïàö³ºíò³â òà ¿õ ðîäèí. ²ç äîñòóïîì äî ²íòåðíåòó òà
ëåãê³ñòþ, ç ÿêîþ ïàö³ºíòè ìîæóòü çíàéòè ³íôîðìà-
ö³þ ïðî ¿õ ñòàí, äëÿ ïàö³ºíò³â çàðàç º äîñèòü ïîøè-
ðåíèì ïîøóê ÷èñëåííèõ äóìîê ïðî ïîñëóãè â ìå-
æàõ îäí³º¿ àáî ð³çíèõ ë³êàðåíü, ùî òàêîæ çá³ëüøóº
âàðò³ñòü äîïîìîãè. Àëå òàêîæ áàãàòî âèùåçãàäà-
íèõ çàõâîðþâàíü ç ïëèíîì íàóêîâîãî òà òåõí³÷íî-
ãî ïðîãðåñó ñòàþòü õðîí³÷íèìè ñòàíàìè, ÿê³ ï³äâè-
ùóþòü ïîòðåáó â ïîñò³éí³é äîïîìîç³ òà ïîñò³éíîìó
ïîïèò³ íà òåðàï³þ, íàïð., ïîòðåáó â ô³çè÷í³é òåðàﳿ,
åðãîòåðàﳿ àáî òåðàﳿ ìîâè òà ìîâëåííÿ.
Ó öüîìó êîíòåêñò³ îáîâ’ÿçêîâîþ º íåîáõ³äí³ñòü
ãàðíîãî ë³äåðñòâà, àäàïòîâàíîãî äî ñó÷àñíèõ ñóñ-
ï³ëüíèõ çì³í ³ ñïîñîáó ìèñëåííÿ, ³íàêøå áóäå ïðî-
105
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
âàë ìåíåäæìåíòó. ßê áóëî çàÿâëåíî Royal College
of Physicians Ëîíäîíó ó 2005 ðîö³, ë³äåðñüê³ íàâè÷êè
ïîâèíí³ áóòè âêëþ÷åí³ äî ï³äãîòîâêè ë³êàðÿ äëÿ
ï³äòðèìêè ïðîôåñ³îíàë³çìó òà ï³äâèùåííÿ ïðîäóê-
òèâíîñò³.
˳êàð³ ïîâèíí³ â÷èòèñÿ ìàêðîñêîï³÷íîìó ïîãëÿ-
äó íà îõîðîíó çäîðîâ’ÿ òà ðîçïîä³ë ðåñóðñ³â53. Âîíè
ïîâèíí³ ìàòè ìîæëèâ³ñòü äîñÿãòè ñï³ëüíî¿ ìåòè íå
ò³ëüêè ç ³íäèâ³äóàëüíî¿ òî÷êè çîðó éîãî àáî ¿¿ ïàö³ºí-
òà, àëå é óñüîãî ñóñï³ëüñòâà. Öå ïåðåäáà÷ຠíå-
îáõ³äí³ñòü âèâ÷åííÿ òà ðîçóì³ííÿ ïîë³òè÷íîãî, åêî-
íîì³÷íîãî òà ñîö³àëüíîãî ñåðåäîâèùà ñèñòåìè, à
òàêîæ åòè÷íîãî ïðîöåñó ïðèéíÿòòÿ ð³øåíü.
˳êàð ÔÐÌ ïîâèíåí àêòèâíî áðàòè ó÷àñòü ó
ðîçðîáö³ ìàðøðóò³â íàäàííÿ äîïîìîãè â ñôåð³ îõî-
ðîíè çäîðîâ’ÿ äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³ òà ðîçðîáëÿòè êë³í³÷í³ íàñòàíîâè, ÿê³ ðåêî-
ìåíäóþòü âòðó÷àííÿ ïðîòÿãîì êîíòèíóóìó
äîïîìîãè, íàïðèêëàä, ïîòðåáè ïðîòÿãîì ãîñòðèõ,
ï³äãîñòðèõ òà äîâãîòðèâàëèõ ôàç õâîðîáè.
 ðàìêàõ ðåàá³ë³òàö³éíî¿ ñëóæáè, íà ìåçî-ð³âí³,
ë³êàð ÔÐÌ ïîâèíåí ðîçâèâàòè óïðàâë³íñüê³ íàâè÷-
êè äëÿ ðîçáóäîâè åôåêòèâíî¿ êîìàíäè. Äàâíî º
â³äîìèì, ùî êîìàíäíèé ï³äõ³ä äî íàäàííÿ äîïîìîãè
º á³ëüø åôåêòèâíèì, í³æ ôðàãìåíòîâàíà äîïîìî-
ãà ïàö³ºíòàì, ³ ë³êàð ÔÐÌ ïîâèíåí êîîðäèíóâàòè
äîïîìîãó ïàö³ºíòó ÷åðåç ð³çíèõ ÷ëåí³â êîìàíäè
(ô³çè÷í³ òåðàïåâòè, åðãîòåðàïåâòè, ñîö³àëüí³ ïðà-
ö³âíèêè òîùî). Íåîáõ³äíî çàîõî÷óâàòè òèïîâ³
ë³äåðñüê³ ÿêîñò³54 çàäëÿ ñïðèÿííÿ êðàùîìó çàäî-
âîëåííþ òà äèíàì³ö³ ãðóïè. Ö³ ÿêîñò³ âêëþ÷àþòü
â ñåáå ãàðí³ êîìóí³êàòèâí³ íàâè÷êè, âì³ííÿ çàîõî-
÷óâàòè ð³çíèõ ÷ëåí³â êîìàíäè äî ó÷àñò³ òà çàëó-
÷åííÿ, ïðîïîíóþ÷è ö³ë³ òà çàâäàííÿ òåðàﳿ, óíèêà-
òè îñîáèñòî¿ êðèòèêè òà äîñÿãíåííÿ ê³íöåâî¿ ìåòè
øëÿõîì êîíñåíñóñó á³ëüøîñò³. Ðåçóëüòàòîì öèõ
çáîð³â êîìàíäè ìຠáóòè âñòàíîâëåííÿ ³íäèâ³äóà-
ë³çîâàíîãî ïëàíó íàäàííÿ äîïîìîãè êîìàíäîþ ³ç
ñïåöèô³÷íèìè ö³ëÿìè, ç âèçíà÷åííÿì êë³í³÷íèõ
âòðó÷àíü, òðèâàëîñò³ òåðàﳿ òà ïðèçíà÷åííÿ îáî-
â’ÿçê³â. ˳êàð ÔÐÌ ïîâèíåí ìàòè ìîæëèâ³ñòü âè-
ÿâëÿòè òà áóòè àðá³òðîì â êîíôë³êòàõ, ÿê³ ìîæóòü
âèíèêíóòè ì³æ ð³çíèìè ÷ëåíàìè êîìàíäè, ³ ïîâè-
íåí ìàòè ìîæëèâ³ñòü óñï³øíî âïîðàòèñÿ ç öèì,
íàïðèêëàä, çàáåçïå÷èòè ìîæëèâ³ñòü îáãîâîðåííÿ,
íàìàãàþ÷èñü óíèêíóòè îñîáèñòèõ äåòàëåé ÷è çâè-
íóâà÷åíü, àáî ñïðèÿòè ïðîâåäåííþ «team building»
äëÿ âèð³øåííÿ êîíôë³êò³â55.
Íà ì³êðî-ð³âí³ ïðîáëåìà äëÿ ë³êàð³â ÔÐÌ æîð-
ñòêî ïîâ’ÿçàíà ç äîâãîòðèâàëèì ìåíåäæìåíòîì
ïàö³ºíò³â, ùî ìîæå âêëþ÷àòè äîâãîòðèâàëó äîïîìî-
ãó, âêëþ÷àþ÷è àäàïòàö³þ äîì³âêè, äîâãîòðèâàëó òà
ï³ñëÿ-ðåàá³ë³òàö³éíó äîïîìîãó, àäàïòîâàíó ô³çè÷íó
àêòèâí³ñòü, áåçïåðåðâíå êîíñóëüòóâàííÿ. Ïàö³ºíòè
ðåàá³ë³òàö³¿ ìàþòü ïîòðåáè â çàãàëüíîìó ìåíåäæ-
106 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ìåíò³, ùî âèõîäèòü çà ðàìêè ïðîñòîãî ìåíåäæìåí-
òó âñåðåäèí³ çàêëàäó ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè, ³ ïðî öå ñë³ä ïîäáàòè ë³êàðÿì ÔÐÌ.
Íàðåøò³, áàãàòî ïàö³ºíò³â, ÿê³ ïîòðåáóþòü ðå-
àá³ë³òàö³¿, ìîæóòü ïåðåñóâàòèñü ÷åðåç áàãàòî çàê-
ëàä³â òà ïîñëóã ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäè-
öèíè, ÿê³ çàçâè÷àé íàäàþòüñÿ ð³çíèìè êîìàíäàìè.
Ó äåÿêèõ ñïåöèô³÷íèõ îáëàñòÿõ, òàêèõ ÿê ³íñóëüò
àáî ñïèííîìîçêîâ³ òðàâìè, áóëè ðîçðîáëåí³ ñïå-
öèô³÷í³ ñõåìè óçãîäæåíî¿ äîïîìîãè ç äîâåäåíîþ
åôåêòèâí³ñòþ, òàê³, ÿê ³íñóëüòí³ áëîêè àáî öåíòðè
ñï³íàëüíî¿ òðàâìè. Ïðîòå, ñë³ä âèçíàòè, ùî, êð³ì
òðàâì ñïèííîãî ìîçêó, ÷è ³íñóëüò³â, äóæå ÷àñòî
ïàö³ºíò, ùî ïîòðåáóº ðåàá³ë³òàö³¿, ñêåðîâóºòüñÿ ç
ãîñòðî¿ ë³êàðí³ äî â³ää³ëåííÿ/ë³êàðí³ ô³çè÷íî¿ òà
ðåàá³ë³òàö³éíî¿ ìåäèöèíè, ï³ñëÿ ÷îãî ïîòðàïëÿº äî
çàêëàä³â äîâãîòðèâàëî¿ äîïîìîãè, ÿê³ ìîæóòü áóòè
àìáóëàòîðíèìè çàêëàäàìè, äîïîìîãîþ â äîìàøí³õ
óìîâàõ àáî ë³êàðíÿìè äîâãîòðèâàëî¿ äîïîìîãè.
Äåÿê³ ç öèõ ïàö³ºíò³â ìîæóòü ìàòè íîâ³ åï³çîäè
÷åðåç ³ñòîð³þ ïðèðîäíîãî ðîçâèòêó çàõâîðþâàííÿ,
³ çíîâó ïî÷èíàòè òå æ ñàìå êîëî, ìîæëèâî, ç ³íøèì
çàê³í÷åííÿì. Ïðîáëåìà º â òîìó, ùî, çàçâè÷àé, íå
³ñíóº ïåâíèõ îðãàí³çàö³éíèõ ìàðøðóò³â, ³ ð³çí³
ñòðóêòóðè ðåàá³ë³òàö³¿, ÿê ïðàâèëî, óïðàâëÿþòüñÿ
ÿê “áóíêåðè”: äëÿ òîãî ñàìîãî ïàö³ºíòà ç ò³ºþ æ
ïðîáëåìîþ êîæåí ðàç çàâæäè ïîâèíí³ áóòè çàñòî-
ñîâàí³ íîâ³ ïëàíè. Áóëè çàïðîïîíîâàí³ ïåâí³ óï-
ðàâë³íñüê³ ð³øåííÿ, íàïð. ì³æðåã³îíàëüí³ ì³æë³êàð-
íÿí³ â³ää³ëåííÿ ÔÐÌ, äëÿ ñïðèÿííÿ öèì ìàðøðóòàì,
ÿê³ ðîçðîáëÿþòüñÿ â äåÿêèõ ðåã³îíàõ ªÑ.
Ó âèñíîâêó, ë³êàð³ ÔÐÌ ïîâèíí³ ìàòè ìîæ-
ëèâ³ñòü ðîçâèâàòè óïðàâë³íñüê³ íàâè÷êè, âðàõîâó-
þ÷è ïîòðåáè ñó÷àñíîãî ñòàíó ìåäèöèíè òà ñèñòåì
îõîðîíè çäîðîâ’ÿ. Âîíè ïîâèíí³ ìàòè ìîæëèâ³ñòü
î÷îëþâàòè ìóëüòè-ïðîôåñ³éíó êîìàíäó, ÿêà ïðà-
öþº ñï³ëüíî ç ³íøèìè äèñöèïë³íàìè, äëÿ îá’ºäíàííÿ
ïåðâèííèõ òà âòîðèííèõ ðåàá³ë³òàö³éíèõ ö³ëåé, ïëà-
íóâàííÿ âòðó÷àííÿ, äåëåãóâàííÿ çàâäàíü äëÿ
ð³çíèõ ÷ëåí³â êîìàíäè òà åôåêòèâíî¿ òà â³ä÷óòíî¿
êîìóí³êàö³¿ ç ïàö³ºíòàìè òà ¿õ ðîäèíàìè. Âîíè ïî-
âèíí³ ìàòè ìîæëèâ³ñòü ìåíåäæìåíòó ïàö³ºíò³â â
äîâãîñòðîêîâ³é ïåðñïåêòèâ³, à òàêîæ ó êîðîòêîñò-
ðîêîâ³é ïåðñïåêòèâ³ çà ¿õ ³íäèâ³äóàëüíèìè ìàðø-
ðóòàìè äîïîìîãè â ð³çíèõ ðåàá³ë³òàö³éíèõ çàêëà-
äàõ, ìîæëèâî, øëÿõîì ñòâîðåííÿ ì³æðåã³îíàëüíèõ
â³ää³ëåíü ÔÐÌ. Çà öèìè êðèòåð³ÿìè, ìàþòü áóòè
îá´ðóíòîâàíèìè çàäîâîëåííÿ â³ä òåðàﳿ, à òàêîæ
åôåêòèâíèé òà åêîíîì³÷íèé ðîçïîä³ë ðåñóðñ³â îõî-
ðîíè çäîðîâ’ÿ.
Êîìóí³êàòèâí³ íàâè÷êè (âêëþ÷àþ÷è
³íôîðìóâàííÿ òà íàâ÷àííÿ ïàö³ºíòà)
Åôåêòèâíà êîìóí³êàö³ÿ ç ïàö³ºíòàìè òà ¿õ äîã-
ëÿäà÷àìè, òàêà, ÿê íàäàííÿ àäåêâàòíî¿ ³íôîðìàö³¿
¹2(2) *2018

òà çàáåçïå÷åííÿ ïðîñâ³òîþ â îõîðîí³ çäîðîâ’ÿ,
â³ä³ãðຠöåíòðàëüíó ðîëü ó ðåàá³ë³òàö³¿ òà º âèçíà-
÷àëüíèìè íàâè÷êàìè äëÿ ë³êàð³â ÔÐÌ.
Îñíîâí³ ö³ë³ êîìóí³êàö³¿ ì³æ ïàö³ºíòîì òà ðåàá³-
ë³òàö³éíîþ êîìàíäîþ âêëþ÷àþòü ñïðèÿííÿ âçàº-
ìî䳿, îáì³íó ³íôîðìàö³ºþ, ïîñèëåííÿ ó÷àñò³ ïàö³ºíòà
òà äîãëÿäà÷³â ó ïðèéíÿòò³ ð³øåíü, óìîæëèâëåííÿ
ñàìîóïðàâë³ííÿ, ðåàãóâàííÿ íà åìîö³¿ òà ìåíåäæ-
ìåíò íåâèçíà÷åíîñò³56. Ïàö³ºíò äóæå äîáðå çíàº
ñâî¿ îáìåæåííÿ æèòòºä³ÿëüíîñò³: â³í âèáèðຠñâîº
ìàéáóòíº, ³ ç ö³º¿ ïðè÷èíè ïîâèíåí àêòèâíî áðàòè
ó÷àñòü ó ïðîöåñ³ ïðèéíÿòòÿ ð³øåíü.
Êîìóí³êàö³ÿ ìîæå áóòè òåðàïåâòè÷íîþ ñàìà ïî
ñîá³, êîëè öå ïðèçâîäèòü äî êðàùîãî óïðàâë³ííÿ
åìîö³ÿìè, ñîö³àëüíî¿ ï³äòðèìêè, ðîçøèðåííÿ ìîæ-
ëèâîñòåé òà â³äïîâ³äíîãî âñòàíîâëåííÿ ðåàá³ë³-
òàö³éíèõ ö³ëåé. ʳëüêà ðàíäîì³çîâàíèõ êîíòðîëüîâà-
íèõ òà ïåðåõðåñíèõ äîñë³äæåíü ïîêàçàëè, ùî
ïàö³ºíò-öåíòðè÷íà êîìóí³êàö³ÿ (÷³òê³ ïîÿñíåííÿ,
ñï³â÷óòòÿ, ïîñèëåííÿ ó÷àñò³ ïàö³ºíò³â) êîðåëþº ç
ñïðèÿòëèâèìè á³îëîã³÷íèìè åôåêòàìè (çíèæåííÿ
àðòåð³àëüíîãî òèñêó, ìåíøà òðèâîãà, ìåíøà
ê³ëüê³ñòü ïîøêîäæåíü îðãàí³â ó ïàö³ºíò³â ç ñèñòåì-
íèì ÷åðâîíèì âîâ÷êîì, âèùà ÿê³ñòü æèòòÿ ñåðåä
ïàö³ºíò³â íà ðàê ìîëî÷íî¿ çàëîçè)57.
Ãàðíå ñï³âðîá³òíèöòâî â ðàìêàõ ìóëüòè-ïðî-
ôåñ³éíî¿ êîìàíäè äîïîìàãຠóíèêíóòè íàäì³ðíî¿ òà
íåïîñë³äîâíî¿ ³íôîðìàö³¿. Êîìàíäíà ñï³âïðàöÿ
íàäຠïàö³ºíòîâ³ àäåêâàòíå ñï³ëêóâàííÿ, ñôîðìó-
ëüîâàíå â³äïîâ³äíèì êîìïåòåíòíèì ïðîôåñ³îíà-
ëîì. Á³ëüø òîãî, êëþ÷îâèì ìîìåíòîì º ïî-
ñë³äîâí³ñòü îòðèìàíèõ ïîâ³äîìëåíü, à íå
çàïëóòóâàííÿ ïàö³ºíò³â òà ¿õ ðîäèí.
Âñåá³÷íà ³íôîðìàö³ÿ, íàäàíà ë³êàðåì ÔÐÌ
ùîäî ïðè÷èíè, ïðèðîäíîãî ïåðåá³ãó òà ïðîãíîçó
ñòàíó çäîðîâ’ÿ, çàïðîïîíîâàíî¿ òåðàﳿ, ¿¿ ìå-
õàí³çì³â 䳿, î÷³êóâàíîãî ôóíêö³îíàëüíîãî ðåçóëü-
òàòó òà ìîæëèâèõ ïîá³÷íèõ åôåêò³â, äîïîìàãàº
ïàö³ºíòîâ³ ñôîðìóâàòè ðàö³îíàëüíå ñòàâëåííÿ äî
òåðàﳿ, ñïðèÿº éîãî êîìïëàºíòíîñò³ òà àêòèâí³é
ó÷àñò³ â òåðàﳿ. Ó êîíòåêñò³ ñåðéîçíèõ, ïîòåíö³é-
íî íåâèë³êîâíèõ õâîðîá (òàêèõ, ÿê ðàê) ç ïîãàíèì
ïðîãíîçîì, ïîâ’ÿçàíèì ³ç çàõâîðþâàííÿì, ëþäè
çàçâè÷àé ïîêëàäàþòüñÿ íà ³íøèõ, ùîá äîïîìîãòè
¿ì äóìàòè ³ â³ä÷óâàòè ñåáå êðàùå ÷åðåç ñêëàäí³
ð³øåííÿ. Ç ³íøîãî áîêó, ïðè ïîãàíîìó ïðîãíîç³
ôóíêö³îíàëüíîãî â³äíîâëåííÿ (ïðè ñïèííîìîçêîâ³é
òðàâì³), äå º çíà÷íî ìåíøå ðîçóì³ííÿ, ³ äå ñïîä³-
âàííÿ (òà î÷³êóâàííÿ) ùî â³äíîâëåííÿ áóäóòü
á³ëüøèìè, ïàö³ºíò òà äîãëÿäà÷³ ìîæóòü íå áóòè
ñïðîìîæíèìè óòðèìóâàòè íàäàíó ³íôîðìàö³þ, äî
ÿêî¿ âîíè íå ãîòîâ³58. Ñòèëü êîìóí³êàö³¿ º äóæå
âàæëèâèì ó öüîìó êîíòåêñò³; ë³êàð³ ÔÐÌ ïîâèíí³
áóòè íàâ÷åí³, ÿê íàäàâàòè ³íôîðìàö³þ, ÿêà ìîæå
ñóïåðå÷èòè ïåðâèííèì î÷³êóâàííÿì ïàö³ºíòà.
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 6 – ÇÍÀÍÍß ÒÀ ÍÀÂÈ×ÊÈ Ë²ÊÀв ÔÐÌ
Ïîðóøåííÿ ïñèõîñîö³àëüíî¿ àäàïòàö³¿ äî îáìå-
æåíü æèòòºä³ÿëüíîñò³ º ÷àñò³øèì ó ïàö³ºíò³â ç îç-
íàêàìè êîãí³òèâíèõ ðîçëàä³â59. Ïàö³ºíòîâ³, ÿêèé
÷åðåç ñòàí çäîðîâ’ÿ ìຠîáìåæåííÿ æèòòºä³ÿëü-
íîñò³, àáî ìîæå çàçíàòè îáìåæåíü æèòòºä³ÿëü-
íîñò³, ñë³ä íàäàòè ³íôîðìàö³þ ïðî òå, ÿê îáìåæåííÿ
æèòòºä³ÿëüíîñò³ ìîæå ïðèçâåñòè äî ñîö³àëüíî¿ íå-
äîñòàòíîñò³ àáî ñîö³àëüíî¿ ³çîëÿö³¿, ÿê ìîæíà çà-
ïîá³ãòè öüîìó ïðîöåñîâ³ òà ðîçïîâ³ñòè ïðî ïðàâà
îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³60. Çâ’ÿçîê ì³æ
íàäàâà÷åì ïîñëóã îõîðîíè çäîðîâ’ÿ ³ ïàö³ºíòîì òà
îñîáàìè, ÿê³ º çíà÷óùèìè äëÿ íå¿/íüîãî òà ¿¿/éîãî
äîãëÿäà÷àìè íå ïîâèíåí îáìåæóâàòèñÿ îäíî-
á³÷íèì ðóõîì ³íôîðìàö³¿, à, ñêîð³øå, çàáåçïå÷óâà-
òè ïðîöåñ âçàºìíîãî îáì³íó ³íôîðìàö³ºþ. Çíàííÿ,
îòðèìàíå â³ä ïàö³ºíòà ùîäî éîãî æèòòºâîãî äîñâ³-
äó îáìåæåíü æèòòºä³ÿëüíîñò³, ìຠâàæëèâå çíà-
÷åííÿ äëÿ â³äïîâ³äíîãî âñòàíîâëåííÿ ðåàá³ë³òàö³é-
íèõ ö³ëåé, âèáîðó àäåêâàòíèõ äîïîì³æíèõ òåõíîëîã³é
òà â³äïîâ³äíèõ ñîö³àëüíèõ âòðó÷àíü. Ó ïðîöåñ³ ïðèé-
íÿòòÿ ð³øåíü ïåðñïåêòèâà ëþäèíè, ÿêà çàçíàëà, àáî
ìîæå çàçíàòè îáìåæåíü æèòòºä³ÿëüíîñò³, äîçâîëÿº
³íòåãðóâàòè áåçë³÷ ôàêòîð³â ç ìåòîþ â³äêðèòòÿ êîí-
ñòðóêòèâíî¿ äèñêóñ³¿ ïðî æèòòºâèé ïëàí.
Íàâ÷àííÿ ïàö³ºíòà
Âàæëèâà ðîëü ë³êàðÿ ÔÐÌ – öå ðåàãóâàòè íà
ïîòðåáó ïàö³ºíòà ùîäî âñåá³÷íî¿ ³íôîðìàö³¿ ïðî
ñó÷àñí³ äîêàçè äåÿêèõ ìåòîä³â òà çàñîá³â âòðó÷àí-
íÿ (íàïð. õàð÷îâèõ äîáàâîê, äåÿêèõ êîìïëåìåí-
òàðíèõ òà àëüòåðíàòèâíèõ ìåòîä³â), ÿê³ äîáðå ðåê-
ëàìóþòüñÿ, õî÷à çàçâè÷àé âîíè ìàþòü ñëàáê³
äîêàçè. Çíà÷íà ÷àñòèíà ³íôîðìàö³¿ ïðî ö³ ìåòîäè,
íà ÿêó ïîòðàïëÿþòü êîðèñòóâà÷³, º êîìåðö³éíîþ çà
íàì³ðàìè, òà ç çàãðîçîþ äåç³íôîðìàö³¿61.
Íàâ÷àííÿ â îõîðîíè çäîðîâ’ÿ, ÿê âòðó÷àííÿ,
ñòîñóºòüñÿ ÿê îêðåìèõ ëþäåé, òàê ³ ñóñï³ëüñòâà,
òà âèçíàíî Ðàäîþ ªâðîïè, ÿê îñíîâíèé åëåìåíò
ïðîô³ëàêòèêè îáìåæåíü æèòòºä³ÿëüíîñò³60. Ñåðåä
áàãàòüîõ âèçíà÷åíü íàâ÷àííÿ ïàö³ºíò³â, ïîâ’ÿçàíî-
ãî ç³ çäîðîâ’ÿì, Ãðóïà Cochrane collaboration ïî-
ãîäèëàñÿ ðîçïî÷àòè «íàâ÷àííÿ àáî òðåíóâàííÿ
ïàö³ºíò³â ñòîñîâíî âëàñíèõ ïîòðåá â ãàëóç³ îõîðî-
íè çäîðîâ’ÿ»62.
Íåäàâí³ çì³íè â ïðàêòèö³ îõîðîíè çäîðîâ’ÿ òà
ðåàá³ë³òàö³¿ (çìåíøåííÿ òðèâàëîñò³ ïåðåáóâàííÿ â
ë³êàðí³, äåô³öèò ïåðñîíàëó, çá³ëüøåííÿ ïîïóëÿð-
íîñò³ ïåðåäîâèõ òåõíîëîã³é) ï³äâèùóþòü ïîòðåáó
â åôåêòèâíîìó íàâ÷àíí³ ïàö³ºíò³â, ÿêå ñïðÿìîâà-
íå íà ñàìîóïðàâë³ííÿ òà ïðîìîö³þ çäîðîâ’ÿ. Âè-
ì³ðè íàâ÷àííÿ ïàö³ºíò³â âêëþ÷àþòü:
– çíàííÿ, ñïðèéíÿòòÿ òà ïåðåêîíàííÿ ùîäî ñòà-
íó çäîðîâ’ÿ, éîãî íàñë³äê³â, ë³êóâàëüíèõ òà
ïðîô³ëàêòè÷íèõ çàõîä³â. Êîãí³òèâí³ âèì³ðè çíàíü
ç îõîðîíè çäîðîâ’ÿ îõîïëþþòü: ³äåíòè÷í³ñòü
107
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
(íàçâà ñòàíó òà ñàìîîö³íêà òÿæêîñò³), òðè-
âàë³ñòü (õðîí³÷íà ÷è ãîñòðà ïðîáëåìà), íàñë³äêè
(ô³çè÷í³, ñîö³àëüí³ òà åêîíîì³÷í³), ïðè÷èíè (îñî-
áèñò³ óÿâëåííÿ ïðî ïðè÷èíè ñòàíó) òà êîíòðîëü
(äóìêà ïàö³ºíòà ïðî çäàòí³ñòü êîíòðîëþâàòè
õâîðîáó)63;
– ìîæëèâîñò³ âèð³øåííÿ ïðîáëåì: ïðîáëåìíà îð-
³ºíòàö³ÿ (ìîòèâàö³ÿ, ñòàâëåííÿ, ñòèë³ ìèñëåííÿ)
òà íàâè÷êè âèð³øåííÿ (âèçíà÷åííÿ ïðîáëåìè,
ñòâîðåííÿ àëüòåðíàòèâ, ïðèéíÿòòÿ ð³øåíü òà
ðåàë³çàö³ÿ ð³øåííÿ)64;
– ëîêóñ-êîíòðîëü çäîðîâ’ÿ òà ñïðèéíÿòòÿ ñàìî-
ñò³éíî¿ åôåêòèâíîñò³65:
– ïîâåä³íêè, ïîâ’ÿçàí³ ç³ çäîðîâ’ÿì;
– ñòðàòåã³ÿ ïîäîëàííÿ.
Ðîäèíè/äîãëÿäà÷³ òàêîæ â³ä³ãðàþòü âàæëèâó
ðîëü ó íàâ÷àíí³ ïàö³ºíò³â. ¯õ âêëþ÷åííÿ äî ãðóïî-
âîãî íàâ÷àííÿ äëÿ ñòàö³îíàðíèõ õâîðèõ ñïðèÿº
á³ëüø ðåàë³ñòè÷íîìó ïëàíóâàííþ âèïèñêè òà
çá³ëüøóº ó÷àñòü äîãëÿäà÷³â ó ïîäàëüø³é äîïî-
ìîç³66. Âòðó÷àííÿ ùîäî ñ³ìåé ïàö³ºíò³â ç âàæêè-
ìè îáìåæåííÿìè æèòòºä³ÿëüíîñò³ çàçâè÷àé ñêëà-
äàþòüñÿ ç ³íäèâ³äóàëüíîãî êîíñóëüòóâàííÿ,
ïðîñâ³òè òà ãðóïîâî¿ ï³äòðèìêè. ßê îñâ³òà, òàê ³
êîíñóëüòóâàííÿ çíà÷íî ïîêðàùóþòü çíàííÿ äîãëÿ-
äà÷³â òà ñòàá³ë³çóþòü ôóíêö³îíóâàííÿ îñîáàìè, ÿê³
º çíà÷óùèìè, õî÷à êîíñóëüòóâàííÿ º á³ëüø åôåê-
òèâíèì, í³æ ëèøå ïðîñâ³òà ïîîäèíö³67.
Âàæëèâèì º ÷àñ äîíåñåííÿ îñâ³òíüîãî âì³ñòó.
Öå òàêîæ ñòîñóºòüñÿ íàäàííÿ ³íôîðìàö³¿ ïàö³ºíòó
òà äîãëÿäà÷àì68. Ó ðàíí³é ðåàá³ë³òàö³¿, êîëè äîì³-
íóþòü á³îìåäè÷í³ òåìè, îñâ³òí³ ö³ë³ ïîâèíí³
â³ääçåðêàëþâàòè òåðàïåâòè÷íèé ïðîöåñ. Ïñèõî-
ëîã³÷í³ òà ìåäèêî-ñîö³àëüí³ àñïåêòè, ñïðÿìîâàí³ íà
ïîâåä³íêó, ïîâ’ÿçàíó ³ç çäîðîâ’ÿì, ïîâñÿêäåíí³
çâè÷êè, ïðîôåñ³éíó îñâ³òó, âèâ÷åííÿ ñîö³àëüíèõ
íàâè÷îê, ïîâèíí³ ïî÷èíàòèñÿ â ï³äãîñòð³é ðåàá³ë³-
òàö³¿ ç óðàõóâàííÿì ïñèõîëîã³÷íèõ ïðîöåñ³â ñïðèé-
íÿòòÿ îáìåæåíü æèòòºä³ÿëüíîñò³. Íàéáëèæ÷³ íà-
ñë³äêè ïðîñâ³òè çàëåæàòü â³ä êîíòåêñòó äîïîìîãè.
Öå ìîæå ñêëàäàòèñÿ ç íàâè÷îê (âì³ííÿ êîðèñòó-
âàòèñÿ â³çêîì, ïîâ³äîìëÿòè ïðî íåîáõ³äí³ñòü,
âì³ííÿ äîãëÿäà÷à âèêîíóâàòè ïàñèâí³ âïðàâè),
ñòàâëåííÿ òà çíàííÿ (ìîòèâàö³ÿ äî ñàìîñò³éíîãî
âèêîíàííÿ âïðàâ, ïåðåêîíàííÿ, ùî á³ëü, ïîâ’ÿçàíèé
ç ðàêîì, ìîæå áóòè åôåêòèâíî êîíòðîëüîâàíèì).
ϳä ÷àñ õðîí³÷íî¿ ñòà䳿 çì³ñò îñâ³òè ìຠîõîïëþ-
âàòè ñîö³àëüíî âàæëèâ³ ïèòàííÿ, à òàêîæ çàïîá³ãàí-
íÿ âòîðèííèõ ñòàí³â.
Äîâãîòðèâàë³ ö³ë³ íàâ÷àííÿ ïàö³ºíò³â, çàçâè÷àé,
âêëþ÷àþòü ñîö³àëüíó ³íòåãðàö³þ, íåçàëåæí³ñòü,
ïîë³ïøåííÿ ñòàíó ðèçèêó äëÿ çäîðîâ’ÿ, ï³äòðèìêó
ô³çè÷íî¿ òà ïðîôåñ³éíî¿ àêòèâíîñò³, ïîâåä³íêîâ³
çâè÷êè çàõèñòó çäîðîâ’ÿ (íàïð. ðåãóëÿðíå òðåíó-
âàííÿ, àäåêâàòíà 䳺òà, çàõèñò ñòîï ïðè ä³àáåò³),
108 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
çáåðåæåííÿ àäåêâàòíèõ çíàíü ïðî ñòàí çäîðîâ’ÿ,
ðåàë³ñòè÷í³ î÷³êóâàííÿ ùîäî ðåçóëüòàòó, àêòèâíå
ñòàâëåííÿ äî òåðàﳿ. Ñïèñîê çðàçê³â íàâ÷àëüíîãî
âì³ñòó ïðè âèáðàíèõ ñòàíàõ çäîðîâ’ÿ íàâåäåíèé â
Òàáëèö³ ² 76-101.
Ìåòîäîëîã³ÿ íàâ÷àííÿ ïàö³ºíò³â ïîâèííà äîïîâ-
íèòè çàãàëüíèé ðåàá³ë³òàö³éíèé ïðîöåñ òà áóòè ðå-
çóëüòàòîì ñï³âïðàö³ ìóëüòè-ïðîôåñ³éíî¿ êîìàíäè.
Âñ³ ÷ëåíè êîìàíäè íåñóòü â³äïîâ³äàëüí³ñòü çà âè-
êîíàííÿ åëåìåíò³â íàâ÷àííÿ ïàö³ºíòà â³äïîâ³äíî äî
¿õ ñôåðè êîìïåòåíòíîñòåé. ˳êàð ÔÐÌ, ÿê ë³äåð
êîìàíäè, â³äïîâ³äຠçà êîîðäèíàö³þ îñâ³òíüîãî
ïðîöåñó, âêëþ÷íî ç íàäàííÿì êðèòè÷íî¿ ³íôîðìàö³¿
(ùîäî ä³àãíîçó òà ïðîãíîçó, îñîáëèâî ó âèïàäêó
ïîñò³éíî¿ âòðàòè ôóíêö³¿) òà îö³íþâàííÿ ôàêòîð³â,
ùî âïëèâàþòü íà çäàòí³ñòü ïàö³ºíòà âñòàíîâëþâà-
òè ðåàá³ë³òàö³éí³ ö³ë³69. Íàâ÷àëüí³ ìåòîäè ïîâèíí³
áóòè àäàïòîâàí³ äî äîñâ³äó ïàö³ºíòà òà íàéá³ëüø
ïîøèðåíèõ ïñèõîëîã³÷íèõ ïðîô³ë³â, õàðàêòåðíèõ
äëÿ ïåâíîãî ñòàíó çäîðîâ’ÿ65. ²íòåíñèâí³ñòü íà-
â÷àííÿ, î÷³êóâàíèé íàéáëèæ÷èé åôåêò òà ä³àïàçîí
íàäàíî¿ ³íôîðìàö³¿ ïîâèíí³ áóòè ñêîðèãîâàíèìè
â³äïîâ³äíî äî ñòà䳿 ë³êóâàííÿ òà ïîïèòó ïàö³ºíòà
(íàïð. îñâ³òà ùîäî ñåêñóàëüíîñò³ ïðîòÿãîì ãîñ-
òðî¿ ðåàá³ë³òàö³¿ ïðè ïàðàïëå㳿 ïîâèííà îáìåæóâà-
òèñÿ ïðîñòîþ ³íôîðìàö³ºþ ïðî òå, ùî çäàòí³ñòü äî
äîñÿãíåííÿ çàäîâîëåííÿ íå áóäå âòðà÷åíà, òîä³ ÿê
ó õðîí³÷í³é ñòà䳿 çì³ñò òà ôîðìà ïðîñâ³òè ïîâèíí³
ïîâí³ñòþ â³äïîâ³äàòè ïîòðåáàì ïàö³ºíòà òà ïàðò-
íåðà)58. Ïðîöåñ íàâ÷àííÿ ïîâèíåí âêëþ÷àòè âèç-
íà÷åííÿ áàð’ºð³â íàâ÷àííÿ, îòðèìàííÿ ÿê çíàíü,
òàê ³ ïðàêòè÷íèõ íàâè÷îê, îö³íêó òà ïîçèòèâíå
ï³äêð³ïëåííÿ. Çàñòîñóâàííÿ ñó÷àñíèõ ìåòîä³â íà-
â÷àííÿ (á³îëîã³÷íîãî çâîðîòíîãî çâ’ÿçêó, òåëå-íà-
â÷àííÿ) òà ìàòåð³àë³â (³íòåðàêòèâí³ ïëàòôîðìè,
³ãðè) ïîâèííî â³äïîâ³äàòè ìåòîäàì á³îïñèõîñîö³-
àëüíèõ âòðó÷àíü58. Òîâàðèñòâà ÔÐÌ òà ðåàá³ë³-
òàö³éí³ öåíòðè ïîâèíí³ ïóáë³êóâàòè îñâ³òí³ ìàòåð³-
àëè íà îñíîâ³ äîêàç³â 65,70 . Ó÷àñòü ð³âíèõ
êîíñóëüòàíò³â ó íàâ÷àíí³ ïàö³ºíò³â º âñå á³ëüø ïî-
ïóëÿðíèì ïðè ïåâíèõ ñòàíàõ çäîðîâ’ÿ (ñïèííîìîç-
êîâ³ òðàâìè, àìïóòàö³¿). Öåé ï³äõ³ä ï³äí³ìຠðîëü
ë³êàðÿ ÔÐÌ, ÿêèé ïîâèíåí ïåðåâ³ðÿòè ÿê³ñòü òà
çì³ñò íàâ÷àííÿ71.
Ñèñòåìàòè÷í³ îãëÿäè òà ìåòà-àíàë³çè ïîêàçó-
þòü, ùî õî÷à âòðó÷àííÿ ùîäî çàîõî÷åííÿ
ïàö³ºíò³â äî ðîçóì³ííÿ òà óïðàâë³ííÿ ¿õ õðîí³÷íè-
ìè ñòàíàìè, ï³äâèùåííÿ êîìïëàºíòíîñò³ ïàö³ºíòà,
âíåñêó äîãëÿäà÷³â äî ïðîäîâæåííÿ òåðàﳿ ³ º áà-
ãàòîîá³öÿþ÷èìè òà ðàö³îíàëüíèìè, àëå âèÿâëÿ-
þòüñÿ íåäîñòàòíüî äîêàçîâèìè ùîäî ôóíêö³îíó-
âàííÿ, ó÷àñò³, ÿêîñò³ æèòòÿ, âèêîðèñòàííÿ ïîñëóã,
çíèæåííÿ ïðÿìèõ òà íåïðÿìèõ âèòðàò íà òåðàï³þ.
Âïëèâ ïðîñâ³òè º á³ëüø äîêàçîâèì ó ñêëàäíèõ
ïàö³ºíò³â62,71,72.
¹2(2) *2018
 ÐÎÇÄ²Ë 6 – ÇÍÀÍÍß ÒÀ ÍÀÂÈ×ÊÈ Ë²ÊÀв ÔÐÌ

Òàáëèöÿ I. Ïðèêëàäè îñâ³òí³õ ïîòðåá ïðè âèáðàíèõ ñòàíàõ çäîðîâ’ÿ71-96.

ɋɬɚɧ ɡɞɨɪɨɜ’ɹ
ɇɟɜɪɨɥɨɝɿɱɧɿ ɪɨɡɥɚɞɢ ɭ ɞɿɬɟɣ
(ɰɟɪɟɛɪɚɥɶɧɢɣ ɩɚɪɚɥɿɱ, ɇɑɆɌ)
ɋɬɚɧɢ ɡ ɤɨɝɧɿɬɢɜɧɢɦɢ ɩɨɪɭɲɟɧɧɹɦɢ
(ɧɚɩɪ. ɞɟɦɟɧɰɿɹ, ɇɑɆɌ, ɩɫɢɯɿɱɧɚ
ɡɚɬɪɢɦɤɚ)
ɋɬɚɧɢ ɡɞɨɪɨɜ'ɹ, ɳɨ ɫɭɩɪɨɜɨɞɠɭɸɬɶɫɹ
ɞɟɩɪɟɫɿɽɸ
Ɋɨɡɥɚɞɢ ɡɿ ɫɩɚɫɬɢɱɧɿɫɬɸ
ɏɜɨɪɨɛɚ ɉɚɪɤɿɧɫɨɧɚ
Ɇɧɨɠɢɧɧɢɣ ɫɤɥɟɪɨɡ
ɋɩɢɧɧɨɦɨɡɤɨɜɿ ɬɪɚɜɦɢ,
ɦɿɽɥɨɦɟɧɿɧɝɨɰɟɥɟ
ɇɟɫɩɟɰɢɮɿɱɧɿ ɛɨɥɶɨɜɿ ɪɨɡɥɚɞɢ ɫɩɢɧɢ
ɿ ɲɢʀ
ȼɬɪɚɬɚ ɤɿɧɰɿɜɨɤ
Ɉɫɬɟɨɚɪɬɪɢɬ, ɡɚɩɚɥɶɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ
ɫɭɝɥɨɛɿɜ
Ɉɫɬɟɨɩɨɪɨɡ
Ɇɿɨɮɚɫɰɿɚɥɶɧɢɣ ɛɿɥɶ
ɉɟɪɢɮɟɪɢɱɧɿ ɧɟɣɪɨɩɚɬɿʀ
ɜɟɪɯɧɶɨʀ ɤɿɧɰɿɜɤɢ
Ⱥɪɬɟɪɿɚɥɶɧɚ ɝɿɩɟɪɬɟɧɡɿɹ, ɿɲɟɦɿɱɧɚ
ɯɜɨɪɨɛɚ ɫɟɪɰɹ, ɰɭɤɪɨɜɢɣ ɞɿɚɛɟɬ,
ɨɠɢɪɿɧɧɹ
ɏɪɨɧɿɱɧɟ ɨɛɫɬɪɭɤɬɢɜɧɟ ɡɚɯɜɨɪɸɜɚɧɧɹ
ɥɟɝɟɧɿɜ
Ɉɧɤɨɥɨɝɿɱɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ
Ʌɿɦɮɟɞɟɦɚ
ɏɜɨɪɨɛɢ ɭ ɡɚɤɥɸɱɧɿɣ ɫɬɚɞɿʀ
Ʌɿɬɧɿɣ ɜɿɤ
ɇɑɆɌ – ɧɚɛɭɬɚ ɱɟɪɟɩɧɨ-ɦɨɡɤɨɜɚ ɬɪɚɜɦɚ, Ⱥɉɀ – ɚɤɬɢɜɧɨɫɬɿ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ
Ɉɫɜɿɬɧɿɣ ɫɩɟɤɬɪ
ɉɚɰɿɽɧɬ: ɮɨɪɦɭɜɚɧɧɹ ɬɚ ɩɿɞɬɪɢɦɤɚ ɫɨɰɿɚɥɶɧɢɯ ɜɿɞɧɨɫɢɧ, ɜɢɤɨɪɢɫɬɚɧɧɹ
ɞɨɩɨɦɿɠɧɢɯ ɩɪɢɫɬɪɨʀɜ, ɭɱɚɫɬɶ ɭ ɞɨɡɜɿɥɥɿ
Ⱦɨɝɥɹɞɚɱɿ: ɡɞɚɬɧɿɫɬɶ ɡɦɟɧɲɭɜɚɬɢ ɫɬɪɟɫ ɿ ɧɚɜɚɧɬɚɠɟɧɧɹ ɞɨɝɥɹɞɚɱɚ, ɤɨɧɮɥɿɤɬɢ
ɡ ɞɨɝɥɹɞɚɱɟɦ, ɩɨɤɪɚɳɟɧɧɹ ɤɟɪɭɜɚɧɧɹ ɩɪɨɛɥɟɦɚɦɢ ɩɨɜɟɞɿɧɤɢ ɞɢɬɢɧɢ, ɬɟɯɧɿɤɢ
ɮɿɡɢɱɧɢɯ ɜɩɪɚɜ
ɉɚɰɿɽɧɬ: ɤɨɦɭɧɿɤɚɰɿɹ (ɜɤɥɸɱɚɸɱɢ ɧɟɜɟɪɛɚɥɶɧɟ ɫɩɿɥɤɭɜɚɧɧɹ), Ⱥɉɀ, ɞɨɡɜɿɥɥɹ
ɬɚ ɩɪɨɮɟɫɿɣɧɚ (ɹɤɳɨ ɦɨɠɥɢɜɨ) ɚɤɬɢɜɧɿɫɬɶ
Ⱦɨɝɥɹɞɚɱɿ: ɬɟɯɧɿɤɢ ɦɟɞɫɟɫɬɪɢɧɫɶɤɨɝɨ ɞɨɝɥɹɞɭ, ɪɨɡɭɦɿɧɧɹ ɩɨɬɪɟɛ ɩɚɰɿɽɧɬɚ
ɉɚɰɿɽɧɬ: Ⱥɉɀ, ɜɢɪɚɡ ɟɦɨɰɿɣ, ɞɨɡɜɿɥɥɹ ɬɚ ɩɪɨɮɟɫɿɣɧɚ ɚɤɬɢɜɧɿɫɬɶ
Ⱦɨɝɥɹɞɚɱɿ: ɪɨɡɭɦɿɧɧɹ ɜɩɥɢɜɭ ɡɚɯɜɨɪɸɜɚɧɧɹ, ɩɨɬɪɟɛɢ ɩɚɰɿɽɧɬɚ
ɉɚɰɿɽɧɬ: ɳɨɞɟɧɧɿ ɜɩɪɚɜɢ ɧɚ ɪɨɡɬɹɝɧɟɧɧɹ, ɬɟɯɧɿɤɢ ɪɟɥɚɤɫɚɰɿʀ
Ⱦɨɝɥɹɞɚɱɿ: ɬɟɯɧɿɤɢ ɦɟɞɫɟɫɬɪɢɧɫɶɤɨɝɨ ɞɨɝɥɹɞɭ ɬɚ ɬɟɯɧɿɤɢ ɜɩɪɚɜ, ɜɢɤɨɪɢɫɬɚɧɧɹ
ɲɢɧ (ɹɤɳɨ ɩɨɤɚɡɚɧɨ)
ɉɚɰɿɽɧɬ ɿ ɞɨɝɥɹɞɚɱɿ: ɪɨɡɭɦɿɧɧɹ ɩɪɨɰɟɫɭ ɡɚɯɜɨɪɸɜɚɧɧɹ, ɬɟɯɧɿɤɢ ɮɿɡɢɱɧɢɯ ɜɩɪɚɜ,
ɩɿɞɬɪɢɦɤɚ ɫɨɰɿɚɥɶɧɢɯ ɜɿɞɧɨɫɢɧ
ɉɚɰɿɽɧɬ: Ⱥɉɀ, ɟɪɝɨɧɨɦɿɤɚ, ɬɟɯɧɿɤɢ ɟɧɟɪɝɨɡɛɟɪɟɠɟɧɧɹ
Ⱦɨɝɥɹɞɚɱɿ: ɬɟɯɧɿɤɢ ɦɟɞɫɟɫɬɪɢɧɫɶɤɨɝɨ ɞɨɝɥɹɞɭ ɬɚ ɬɟɯɧɿɤɢ ɮɿɡɢɱɧɢɯ ɜɩɪɚɜ
ɉɚɰɿɽɧɬ: ɜɢɤɨɪɢɫɬɚɧɧɹ ɜɿɡɤɿɜ ɬɚ ɿɧɲɢɯ ɞɨɩɨɦɿɠɧɢɯ ɩɪɢɫɬɪɨʀɜ, ɦɟɧɟɞɠɦɟɧɬ
ɛɨɥɸ, Ⱥɉɀ, ɩɪɨɮɟɫɿɣɧɚ ɚɤɬɢɜɧɿɫɬɶ
ɉɚɰɿɽɧɬ ɿ ɞɨɝɥɹɞɚɱɿ: ɩɪɨɮɿɥɚɤɬɢɤɚ ɩɪɨɥɟɠɧɿɜ, ɞɨɝɥɹɞ ɡɚ ɫɟɱɨɜɢɦ ɦɿɯɭɪɨɦ
ɿ ɤɢɲɤɨɜɢɤɨɦ, ɫɟɤɫɭɚɥɶɧɿɫɬɶ, ɮɟɪɬɢɥɶɧɿɫɬɶ, ɬɟɯɧɿɤɢ ɮɿɡɢɱɧɢɯ ɜɩɪɚɜ ɬɚ ɬɟɯɧɿɤɢ
ɦɟɞɫɟɫɬɪɢɧɫɶɤɨɝɨ ɞɨɝɥɹɞɭ
ɉɚɰɿɽɧɬ: ɟɪɝɨɧɨɦɿɤɚ (Ⱥɉɀ, ɪɨɛɨɱɟ ɦɿɫɰɟ, ɞɨɡɜɿɥɥɹ), ɩɿɞɬɪɢɦɤɚ ɚɤɬɢɜɧɨɫɬɿ,
ɮɿɡɢɱɧɿ ɜɩɪɚɜɢ, ɬɟɯɧɿɤɢ ɜɢɛɨɪɭ ɩɨɡɢɰɿʀ
ɉɚɰɿɽɧɬ ɿ ɞɨɝɥɹɞɚɱɿ ɧɚ ɫɬɚɞɿʀ ɩɟɪɟɞ ɚɦɩɭɬɚɰɿɽɸ: ɩɪɨɝɧɨɡ ɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ
ɜɿɞɧɨɜɥɟɧɧɹ, ɳɨ ɨɱɿɤɭɽɬɶɫɹ ɩɿɞ ɱɚɫ ɪɟɚɛɿɥɿɬɚɰɿʀ
ɉɚɰɿɽɧɬ ɧɚ ɫɬɚɞɿʀ ɩɿɫɥɹ ɚɦɩɭɬɚɰɿʀ: Ⱥɉɀ, ɥɨɤɨɦɨɰɿɹ, ɡɚɫɬɨɫɭɜɚɧɧɹ ɩɪɨɬɟɡɿɜ
ɬɚ ɞɨɩɨɦɿɠɧɢɯ ɩɪɢɫɬɪɨʀɜ, ɤɨɧɬɪɨɥɶ ɛɨɥɸ, ɫɨɰɿɚɥɶɧɟ ɠɢɬɬɹ, ɩɪɨɮɟɫɿɣɧɚ
ɚɤɬɢɜɧɿɫɬɶ
ɉɚɰɿɽɧɬ ɿ ɞɨɝɥɹɞɚɱɿ: ɜɢɤɨɪɢɫɬɚɧɧɹ ɞɨɩɨɦɿɠɧɢɯ ɩɪɢɫɬɪɨʀɜ, ɩɿɞɬɪɢɦɤɚ ɿɧɞɟɤɫɭ ɦɚɫɢ
ɬɿɥɚ, ɡɚɯɢɫɬ ɫɭɝɥɨɛɿɜ, ɭɩɪɚɜɥɿɧɧɹ ɫɬɪɟɫɨɦ, ɬɟɯɧɿɤɢ ɟɧɟɪɝɨɡɛɟɪɟɠɟɧɧɹ, ɩɿɞɬɪɢɦɤɚ
ɚɤɬɢɜɧɨɫɬɿ
ɉɚɰɿɽɧɬ ɿ ɞɨɝɥɹɞɚɱɿ: ɞɿɽɬɚ, ɮɿɡɢɱɧɚ ɚɤɬɢɜɧɿɫɬɶ, ɫɬɚɬɢɱɧɿ ɿ ɞɢɧɚɦɿɱɧɿ ɩɨɫɬɭɪɚɥɶɧɿ
ɜɩɪɚɜɢ, ɩɪɨɮɿɥɚɤɬɢɤɚ ɩɚɞɿɧɶ, ɩɪɚɜɢɥɶɧɟ ɜɢɤɨɪɢɫɬɚɧɧɹ ɥɿɤɿɜ (ɧɚɩɪ. ɛɿɫɮɨɫɮɨɧɚɬɿɜ)
ɉɚɰɿɽɧɬ: ɩɪɢɪɨɞɚ ɫɢɦɩɬɨɦɿɜ, ɥɿɤɭɜɚɧɧɹ, ɫɬɪɚɬɟɝɿʀ ɩɪɨɮɿɥɚɤɬɢɤɢ (ɟɪɝɨɧɨɦɿɤɚ,
ɬɟɯɧɿɤɢ ɫɚɦɨɪɨɡɬɹɝɭɜɚɧɧɹ ɿ ɡɦɿɰɧɟɧɧɹ ɦ'ɹɡɿɜ, ɫɚɦɨɦɚɫɚɠ, ɫɚɦɨɫɬɿɣɧɟ
ɜɢɤɨɪɢɫɬɚɧɧɹ ɯɨɥɨɞɭ / ɬɟɩɥɚ), ɬɟɯɧɿɤɢ ɪɟɥɚɤɫɚɰɿʀ
ɉɚɰɿɽɧɬ: ɟɪɝɨɧɨɦɿɤɚ (Ⱥɉɀ, ɪɨɛɨɬɚ, ɞɨɡɜɿɥɥɹ)
ɉɚɰɿɽɧɬ ɿ ɞɨɝɥɹɞɚɱɿ: ɪɨɡɭɦɿɧɧɹ ɮɚɤɬɨɪɿɜ ɪɢɡɢɤɭ ɫɟɪɰɟɜɢɯ ɯɜɨɪɨɛ, ɩɪɨɝɧɨɡ
ɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɜɿɞɧɨɜɥɟɧɧɹ ɩɿɞ ɱɚɫ ɪɟɚɛɿɥɿɬɚɰɿʀ, ɨɛɿɡɧɚɧɿɫɬɶ ɩɪɨ ɡɞɨɪɨɜ’ɹ
(ɳɨɛ ɭɧɢɤɧɭɬɢ ɧɚɞɦɿɪɧɨʀ ɩɢɥɶɧɨɫɬɿ)
ɉɚɰɿɽɧɬ: Ⱥɉɀ, ɦɨɞɢɮɿɤɚɰɿɹ ɯɚɪɱɭɜɚɧɧɹ, ɮɿɡɢɱɧɚ ɚɤɬɢɜɧɿɫɬɶ, ɩɪɨɮɟɫɿɣɧɚ
ɚɤɬɢɜɧɿɫɬɶ, ɩɨɜɟɞɿɧɤɚ, ɩɨɜ’ɹɡɚɧɚ ɡɿ ɡɞɨɪɨɜ’ɹɦ (ɩɪɢɩɢɧɟɧɧɹ ɤɭɪɿɧɧɹ),
ɞɨɝɥɹɞ ɡɚ ɫɬɨɩɚɦɢ (ɩɪɢ ɞɿɚɛɟɬɿ)
ɉɚɰɿɽɧɬ ɿ ɞɨɝɥɹɞɚɱɿ: ɞɢɯɚɥɶɧɿ ɜɩɪɚɜɢ ɿ ɫɚɦɨɨɱɢɳɟɧɧɹ ɞɢɯɚɥɶɧɢɯ ɲɥɹɯɿɜ,
ɡɚɩɨɛɿɝɚɧɧɹ ɡɚɝɨɫɬɪɟɧɶ
ɉɚɰɿɽɧɬ: ɩɨɜɟɞɿɧɤɚ, ɩɨɜ’ɹɡɚɧɚ ɡɿ ɡɞɨɪɨɜ’ɹɦ (ɩɪɢɩɢɧɟɧɧɹ ɤɭɪɿɧɧɹ), ɩɿɞɬɪɢɦɤɚ
ɮɿɡɢɱɧɨʀ ɬɚ ɩɪɨɮɟɫɿɣɧɨʀ ɚɤɬɢɜɧɨɫɬɿ
ɉɚɰɿɽɧɬ ɿ ɞɨɝɥɹɞɚɱɿ: ɦɟɧɟɞɠɦɟɧɬ ɛɨɥɸ, ɩɿɞɬɪɢɦɤɚ ɚɤɬɢɜɧɨɫɬɿ, ɬɟɯɧɿɤɢ ɮɿɡɢɱɧɢɯ
ɜɩɪɚɜ, ɜɢɤɨɪɢɫɬɚɧɧɹ ɞɨɩɨɦɿɠɧɢɯ ɩɪɢɫɬɪɨʀɜ (ɹɤɳɨ ɩɨɤɚɡɚɧɿ), ɩɪɨɮɿɥɚɤɬɢɤɚ ɩɚɞɿɧɶ
ɉɚɰɿɽɧɬ: ɩɪɨɮɿɥɚɤɬɢɤɚ ɡɚɝɨɫɬɪɟɧɶ, ɬɟɯɧɿɤɢ ɫɚɦɨɫɬɿɣɧɨɝɨ ɪɭɱɧɨɝɨ ɞɪɟɧɚɠɭ,
ɩɪɨɮɿɥɚɤɬɢɤɚ ɬɪɚɜɦ ɿ ɞɨɝɥɹɞ ɡɚ ɲɤɿɪɨɸ. ȼɢɤɨɧɚɧɧɹ ɮɿɡɢɱɧɢɯ ɜɩɪɚɜ ɬɚ ɫɩɨɪɬ.
ɉɪɚɜɢɥɶɧɟ ɜɢɤɨɪɢɫɬɚɧɧɹ ɤɨɦɩɪɟɫɿɣɧɨɝɨ ɬɪɢɤɨɬɚɠɭ ɿ/ɚɛɨ ɛɚɧɞɚɠɿɜ
ɉɚɰɿɽɧɬ ɿ ɞɨɝɥɹɞɚɱɿ: ɤɨɧɬɪɨɥɶ ɛɨɥɸ, ɜɢɤɨɪɢɫɬɚɧɧɹ ɞɨɩɨɦɿɠɧɢɯ ɩɪɢɫɬɪɨʀɜ, ɬɟɯɧɿɤɢ
ɦɟɞɫɟɫɬɪɢɧɫɶɤɨɝɨ ɞɨɝɥɹɞɭ ɬɚ ɬɟɯɧɿɤɢ ɮɿɡɢɱɧɢɯ ɜɩɪɚɜ.
Ⱦɨɝɥɹɞɚɱɿ: ɩɥɚɧɢ ɥɿɤɭɜɚɧɧɹ ɬɚ ɩɨɬɪɟɛɢ ɩɚɰɿɽɧɬɚ
ɉɚɰɿɽɧɬ ɿ ɞɨɝɥɹɞɚɱɿ: ɬɟɯɧɿɤɢ ɮɿɡɢɱɧɢɯ ɜɩɪɚɜ, ɞɿɽɬɚ, ɤɨɧɬɪɨɥɶ ɛɨɥɸ, ɩɪɨɮɿɥɚɤɬɢɤɚ
ɩɚɞɿɧɶ, ɨɛʉɪɭɧɬɨɜɚɧɚ ɮɚɪɦɚɤɨɬɟɪɚɩɿɹ, ɜɢɤɨɪɢɫɬɚɧɧɹ ɞɨɩɨɦɿɠɧɢɯ ɩɪɢɫɬɪɨʀɜ.
Ⱦɨɝɥɹɞɚɱɿ: ɪɨɡɭɦɿɧɧɹ ɩɨɬɪɟɛ ɩɚɰɿɽɧɬɚ.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 109
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Ôàêòîðè, ïîâ’ÿçàí³ ç³ çäîðîâ’ÿì, òà îñîáèñò³
ôàêòîðè, ùî ïåðåøêîäæàþòü åôåêòèâíîñò³ êîìó-
í³êàö³¿ òà íàâ÷àííþ ïàö³ºíò³â, âêëþ÷àþòü ìîâó,
ìîâëåííÿ, óñâ³äîìëåííÿ, ïðîáëåìè ñïðèéíÿòòÿ òà
ïàì’ÿò³, ïîãàíèé êîíòðîëü íàä ãí³âîì, äåïðåñ³þ,
àíàìíåç îáìåæåíü æèòòºä³ÿëüíîñò³, ïîâ’ÿçàíèõ ç
íàâ÷àííÿì, çëîâæèâàííÿ, õðîí³÷íèé á³ëü73. Íå çàâ-
æäè ìîæëèâî áðàòèñÿ çà íåâèë³êîâí³ ñòàíè çäîðî-
â’ÿ â³äïîâ³äíî äî çàïèòó ïàö³ºíòà: öå ìîæå çìåí-
øèòè äîâ³ðó äî ôàõ³âö³â îõîðîíè çäîðîâ’ÿ68. Ñåðåä
ôàêòîð³â ñåðåäîâèùà, ùî çíèæóþòü åôåêòèâí³ñòü
íàâ÷àííÿ ïàö³ºíò³â, íàéâàæëèâ³øèìè º íåäîñòàòíÿ
ñîö³àëüíà ï³äòðèìêà73 òà ôàêòîðè, ïîâ’ÿçàí³ ç íà-
äàâà÷åì ïîñëóã îõîðîíè çäîðîâ’ÿ. Äî íèõ â³äíî-
ñÿòüñÿ: íåâ³äïîâ³äí³ñòü íàÿâíîñò³ òà ÷àñó, êîëè
ïàö³ºíò òà äîãëÿäà÷³ ïîâí³ñòþ ðîçóì³þòü ñâî¿ íà-
â÷àëüí³ ïîòðåáè58,74; ìåíøà êîîïåðàö³ÿ àáî âèêî-
ðèñòàííÿ êîíòðîëüîâàíî¿ ïîâåä³íêè; â³äñóòí³ñòü
àäåêâàòíèõ çíàíü àáî â³äñóòí³ñòü êîìïëàºíòíîñò³
(íàïð. ïðè íàäàíí³ äîïîì³æíèõ ïðèñòðî¿â)74,75; íå-
ãàòèâíå ñòàâëåííÿ òà ïåðåêîíàííÿ ùîäî ïðåäìå-
òà îñâ³òè (íàïð. ñåêñóàëüí³ñòü)58; íàäàííÿ ïàö³ºí-
òó íåàäåêâàòíî ãàðíîãî â³ä÷óòòÿ ùîäî éîãî
çäîðîâ’ÿ62; íåõòóâàííÿ øèðøèì êîíòåêñòîì ñåðå-
äîâèùà äîïîìîãè, çíàííÿì ïàö³ºíòà, ö³ííîñòÿìè,
äîñâ³äîì òà ïåðåâàãàìè.
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Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Stefano Negrini,
Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner,
Carlotte Kiekens, Sasa Moslavac, Enrique Varela-Donoso, Anthony B Ward, Mauro Zampolini.
• Ó÷àñíèêè: Jean-Pierre Didier, Sara Laxe, Gilles Rode, Piotr Tederko, Carine Michel, Jean Paysant, Yves
Rossetti, Anthony B Ward, Nino Basaglia, Walter Frontera, Andrew J. Haig, Leonard Li, Jianan Li, Luca
Padua, Dominic Perennou.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ

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Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

(ÔÐM) â ªâðîï³.
Ðîçä³ë 7 – Ñôåðà êë³í³÷íèõ êîìïåòåíòíîñòåé:
ÔÐÌ íà ïðàêòèö³
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
Ó êîíòåêñò³ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ) â ªâðîï³ öåé äîêóìåíò ïðèñâÿ÷åíèé îáñÿãó
òà êîìïåòåíòíîñòÿì ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè, ïî÷èíàþ÷è ç ¿¿ âèçíà÷åííÿ, ÿê «ìåäèöèíè ôóíêö³îíóâàííÿ».
ÔÐÌ âèêîðèñòîâóº ðåàá³ë³òàö³éíó ñòðàòåã³þ îõîðîíè çäîðîâ’ÿ, ÿê ñâîþ îñíîâíó ñòðàòåã³þ ðàçîì ç ë³êóâàëüíîþ
ñòðàòå㳺þ. ³äïîâ³äíî äî ñêëàäíîñò³ ñòàíó çäîðîâ’ÿ, ÿêèé îáìåæóº æèòòºä³ÿëüí³ñòü, ÔÐÌ òàêîæ ñòîñóºòüñÿ ïðîô³ëàê-
òèêè ³ ï³äòðèìêè, ³ çàáåçïå÷óº ³íôîðìàö³ºþ ïàö³ºíò³â òà ³íøèõ äîãëÿäà÷³â.
Ðåàá³ë³òàö³ÿ ïðàöþº â³äïîâ³äíî äî òàê çâàíîãî ðåàá³ë³òàö³éíîãî öèêëó, âêëþ÷àþ÷è îö³íþâàííÿ ç âèçíà÷åííÿì (³íäèâ³-
äóàëüíèõ) ðåàá³ë³òàö³éíèõ ö³ëåé, ïðèçíà÷åííÿ ïðîãðàìè ðåàá³ë³òàö³¿ òà îö³íêó ³íäèâ³äóàëüíèõ ðåçóëüòàò³â.
˳êàð³ ÔÐÌ ë³êóþòü øèðîêèé ñïåêòð çàõâîðþâàíü ³ òðàíñâåðçàëüíî âçàºìîä³þòü ç á³ëüø³ñòþ ìåäè÷íèõ ñïåö³àëüíîñ-
òåé. Âîíè òàêîæ çîñåðåäæóþòüñÿ íà áàãàòüîõ ôóíêö³îíàëüíèõ ïðîáëåìàõ, òàêèõ ÿê ³ììîá³ë³çàö³ÿ, ñïàñòè÷í³ñòü, áîëüîâ³
ñèíäðîìè, ïîðóøåííÿ êîìóí³êàö³¿ òà ³íø³.
ijàãíîç â ô³çè÷í³é òà ðåàá³ë³òàö³éí³é ìåäèöèí³ – öå âçàºìîä³ÿ ì³æ ìåäè÷íèì ä³àãíîçîì òà ñïåöèô³÷íèì ôóíêö³îíàëüíèì
îö³íþâàííÿì â ÔÐÌ. Îñòàííº áàçóºòüñÿ íà êîíöåïòóàëüí³é ñòðóêòóð³ ÌÊÔ òà îòðèìóºòüñÿ çàâäÿêè ôóíêö³îíàëüíèì
îö³íêàì òà øêàëàì: âîíè êëàñèô³êóþòüñÿ â³äïîâ³äíî äî ¿õ îñíîâíîãî ôîêóñó íà ïîðóøåííÿõ, îáìåæåííÿõ àêòèâíîñò³ àáî
îáìåæåííÿõ ìîæëèâîñò³ ó÷àñò³; ôàêòîðè ñåðåäîâèùà òà îñîáèñò³ ôàêòîðè âêëþ÷åí³, ÿê áàð’ºðè àáî ñïðèÿòëèâ³ ÷èííèêè.
²íòåðâåíö³¿ ó ÔÐÌ íàäàþòüñÿ àáî áåçïîñåðåäíüî ë³êàðÿìè ÔÐÌ, àáî çà äîïîìîãîþ êîìàíäè ÔÐÌ. Âîíè âêëþ÷àþòü
øèðîêèé ñïåêòð âòðó÷àíü, âêëþ÷àþ÷è ìåäèêàìåíòîçíå ë³êóâàííÿ, ô³çè÷íó òåðàï³þ, âïðàâè, íàâ÷àííÿ òà áàãàòî ³íøîãî.
Ñòàíäàðòèçîâàí³ ïðîãðàìè ÔÐÌ äîñòóïí³ äëÿ áàãàòüîõ çàõâîðþâàíü òà ôóíêö³îíàëüíèõ ïðîáëåì. Ó á³ëüøîñò³ âèïàäê³â
ðåàá³ë³òàö³ÿ âèêîíóºòüñÿ ìóëüòè-ïðîôåñ³éíèìè êîìàíäàìè, ÿê³ ïðàöþþòü ñï³ëüíî, à òàêîæ ç ³íøèìè äèñöèïë³íàìè ï³ä
êåð³âíèöòâîì ë³êàðÿ ÔÐÌ, ³ öå º ïàö³ºíò-öåíòðè÷íèé ï³äõ³ä.
Ðåçóëüòàòè ³íòåðâåíö³é òà ïðîãðàì ÔÐÌ äåìîíñòðóþòü çìåíøåííÿ ïîðóøåíü ôóíêö³é îðãàí³çìó, îáìåæåíü àêòèâíîñò³
òà âïëèâàþòü íà îáìåæåííÿ ìîæëèâîñò³ ó÷àñò³, à òàêîæ, íà ñêîðî÷åííÿ âèòðàò ³ çíèæåííÿ ñìåðòíîñò³ äëÿ ïåâíèõ ãðóï
ïàö³ºíò³â.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 7. The clinical field of competence: PRM in practice. Eur
J Phys Rehabil Med. 2018 Apr;54(2):230-260.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 7. Ñôåðà êë³í³÷íèõ êîìïåòåíòíîñòåé: ÔÐÌ íà
ïðàêòèö³. Óêðà¿íñüêèé æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 113–144.
Êëþ÷îâ³ ñëîâà: Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà (ÔÐÌ), ñôåðà êîìïåòåíòíîñòåé, ä³àãíîç ó ÔÐÌ, îö³íþâàííÿ ÔÐÌ,

Ââåäåííÿ ³ ñóñï³ëüñòâó, îñíîâè ÔÐÌ, ³ñòîð³ÿ ñïåö³àëüíîñò³

Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî
óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³î-
íàëüíîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòå-
ð³àë³â äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìó-
âàííÿ ïðî ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â
ðåàá³ë³òàö³¿ òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà
âàæëèâîñò³ ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ ñïåö³-
àëüí³ñòþ. Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïîíÿòòÿ
ÔÐÌ, ÷îìó ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì ëþäÿì
ÔÐÌ, ñòðóêòóðà ³ ä³ÿëüí³ñòü îðãàí³çàö³é ÔÐÌ â
ªâðîï³, çíàííÿ ³ íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà
êë³í³÷íèõ êîìïåòåíòíîñòåé ÔÐÌ, ì³ñöå ñïåö³àëü-
íîñò³ ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ ³
ñóñï³ëüñòâ³, îñâ³òà òà áåçïåðåðâíèé ïðîôåñ³éíèé
ðîçâèòîê ë³êàð³â ÔÐÌ, îñîáëèâîñò³ òà ïðîáëåìè
íàóêè òà äîñë³äæåíü â ÔÐÌ òà ïðîáëåìè òà ïåðñ-
ïåêòèâè ìàéáóòíüîãî ÔÐÌ.
Öåé ï³äðîçä³ë ñèñòåìàòè÷íî ïðåäñòàâëÿº ïðàê-
òè÷íó ðîáîòó ë³êàð³â ÔÐÌ ç îïèñîì:
– îáñÿãó òà êîìïåòåíòíîñòåé ô³çè÷íî¿ òà ðåàá³ë³-
òàö³éíî¿ ìåäèöèíè, ïî÷èíàþ÷è ç ¿¿ âèçíà÷åííÿ ÿê
“ìåäèöèíè ôóíêö³îíóâàííÿ”, â³äïîâ³äàëüíî¿ çà
ðåàá³ë³òàö³éíó ñòðàòåã³þ, ùî çàñòîñîâóºòüñÿ ðà-
çîì ³ç ë³êóâàëüíîþ ñòðàòå㳺þ, êîëè îñòàííüî¿

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 113
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
íåäîñòàòíüî äëÿ íàéêðàùîãî â³äíîâëåííÿ
ó÷àñò³ ïàö³ºíò³â; â³äïîâ³äíî äî ñêëàäíîñò³ ñòà-
íó çäîðîâ’ÿ, ÔÐÌ òàêîæ ñòîñóºòüñÿ ïðîô³ëàê-
òèêè òà ï³äòðèìêè, à òàêîæ íàâ÷àííÿ ç ðåàá³ë³-
òàö³¿ äëÿ ³íøèõ ôàõ³âö³â ñôåðè îõîðîíè çäîðîâ’ÿ
òà ìåíåäæìåíòó ïàö³ºíò³â òà äîãëÿäà÷³â;
– ïðîöåñó ðåàá³ë³òàö³¿ â³äïîâ³äíî äî òàê çâàíîãî
ðåàá³ë³òàö³éíîãî öèêëó: ïåðåä íàäàííÿì âòðó-
÷àíü âñ³ ïàö³ºíòè ïîòðåáóþòü îö³íþâàííÿ ç âèç-
íà÷åííÿì ¿õ ³íäèâ³äóàëüíèõ ö³ë³(åé) ïåðåä çàñ-
òîñóâàííÿì âòðó÷àííÿ(íü); íàïðèê³íö³ áóäå
ïðîâåäåíî îö³íêó, äëÿ ïåðåâ³ðêè, ÷è äîñÿã
ïàö³ºíò òîãî, ùî â³í ïîòðåáóâàâ, òà ÷è íåîáõ³ä-
íî ðîçïî÷àòè çíîâó ðåàá³ë³òàö³éíèé öèêë;
– ñïåêòðó çàõâîðþâàíü, ÿêèìè çàéìàþòüñÿ ë³êàð³
ÔÐÌ: íàäàºòüñÿ êîìïëåêñíèé, àëå íå ïîâíèé
ïåðåë³ê íàéá³ëüø âàæëèâèõ ñòàí³â çäîðîâ’ÿ.
Òðàíñâåðçàëüíà ðîëü ô³çè÷íî¿ òà ðåàá³ë³òàö³é-
íî¿ ìåäèöèíè ñåðåä á³ëüøîñò³ ìåäè÷íèõ ñïåö-
³àëüíîñòåé º ÷³òêîþ, ïðîòå î÷åâèäíèì º ïåâíå
ïåðåêðèòòÿ, îñê³ëüêè ôîêóñ ÔÐÌ – öå ðåàá³ë³-
òàö³ÿ (³íîä³ íåïðàâèëüíî íàçèâàºòüñÿ “êîíñåð-
âàòèâíå ë³êóâàííÿ”). Òàêîæ ïðåäñòàâëåí³
íàéá³ëüø ïîøèðåí³ çàãàëüí³ ïðîáëåìè, òàê³, ÿê
³ììîá³ë³çàö³ÿ, ñïàñòè÷í³ñòü, áîëüîâ³ ñèíäðîìè,
ðîçëàäè êîìóí³êàö³¿ òîùî;
– ä³àãíîçó ó ÔÐÌ, ÿê ðåçóëüòàòó âçàºìî䳿 ì³æ
êëàñè÷íèì ìåäè÷íèì ä³àãíîçîì (ÿêèé âèêîðè-
ñòîâóº âñ³ òèïîâ³ ³íñòðóìåíòè ö³º¿ ïðîôåñ³¿) ³ ñïå-
öèô³÷íèì ôóíêö³îíàëüíèì îö³íþâàííÿì ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. Îñòàííº áàçóºòüñÿ
íà êîíöåïòóàëüí³é ìîäåë³ ÌÊÔ, òà îòðèìóºòü-
ñÿ çà äîïîìîãîþ ôóíêö³îíàëüíèõ îö³íîê òà øêàë:
âîíè êëàñèô³êîâàí³ â³äïîâ³äíî äî ¿õ îñíîâíîãî
ôîêóñó íà ïîðóøåííÿõ, îáìåæåííÿõ àêòèâíîñò³
àáî îáìåæåííÿõ ìîæëèâîñò³ ó÷àñò³; ôàêòîðè
ñåðåäîâèùà òà îñîáèñò³ ôàêòîðè âêëþ÷åí³ ÿê
áàð’ºðè àáî ñïðèÿòëèâ³ ÷èííèêè;
– âòðó÷àíü â ô³çè÷í³é òà ðåàá³ë³òàö³éí³é ìåäèöèí³,
ÿê³ íàäàþòüñÿ àáî áåçïîñåðåäíüî ë³êàðÿìè
ÔÐÌ, àáî îïîñåðåäêîâàíî ÷åðåç êîìàíäó ÔÐÌ;
ó öüîìó â³äíîøåíí³ Ñåêö³ºþ ÔÐÌ ªÑÌÑ áóëè
âèçíàí³ ñòàíäàðòèçîâàí³ ïðîãðàìè ç ÔÐÌ;
– ìóëüòè-ïðîôåñ³éíî¿ êîìàíäè ÔÐÌ, ÿê îäíîãî ³ç
ñïîñîá³â, ÿêèì ë³êàð³ ÔÐÌ íàäàþòü âòðó÷àííÿ,
îñîáëèâî â íàéá³ëüø ñêëàäíèõ ðåàá³ë³òàö³éíèõ
óìîâàõ; êîìàíäà ïðàöþº ñï³ëüíî, à òàêîæ ç ³íøè-
ìè äèñöèïë³íàìè òà î÷îëþºòüñÿ ë³êàðåì ÔÐÌ;
– ðåçóëüòàò³â âòðó÷àíü ³ ïðîãðàì ÔÐÌ, ÿê³ º ïà-
ö³ºíò-öåíòðè÷íèìè ³ âêëþ÷àþòü ôóíêö³îíàëüí³
òà îñîáèñò³ ðåçóëüòàòè (çìåíøåííÿ ïîðóøåíü
ôóíêö³é îðãàí³çìó, îáìåæåíü àêòèâíîñò³ ³ âïëèâ
íà îáìåæåííÿ ìîæëèâîñò³ ó÷àñò³), òà âïëèâà-
þòü íà ñêîðî÷åííÿ âèòðàò ³ çíèæåííÿ ñìåðò-
íîñò³ äëÿ ïåâíèõ ãðóï ïàö³ºíò³â.
114 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ñôåðà êîìïåòåíòíîñòåé ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
˳êàð³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
(ÔÐÌ) çàëó÷åí³ äî ìåíåäæìåíòó ïàö³ºíò³â ç áåç-
ë³÷÷þ ð³çíèõ ñòàí³â çäîðîâ’ÿ. ¯õ òóðáóº âïëèâ öèõ
ñòàí³â íà ôóíêö³îíóâàííÿ òà ó÷àñòü ïåðñîíè 1,2.
Ìåäè÷íà ñïåö³àëüí³ñòü ÔÐÌ êîíöåïòóàëüíî îïè-
ñóºòüñÿ ÿê «ìåäèöèíà ôóíêö³îíóâàííÿ»3,4, çàñíîâà-
íà íà ²íòåãðàòèâí³é ìîäåë³ ôóíêö³îíóâàííÿ ÂÎÎÇ
(Äîäàòîê 1). Ïðîáëåìè ôóíêö³îíóâàííÿ âêëþ÷à-
þòü ïîðóøåííÿ ôóíêö³é òà/àáî ñòðóêòóð îðãàí³ç-
ìó, îáìåæåííÿ àêòèâíîñò³ òà îáìåæåííÿ ìîæëè-
âîñò³ ó÷àñò³, ÿê³ ïðåäñòàâëåí³ çàãàëüíèì òåðì³íîì
«îáìåæåííÿ æèòòºä³ÿëüíîñò³», ÿê çàçíà÷åíî â
̳æíàðîäí³é êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ, îáìå-
æåíü æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ)5.
Äëÿ êðàùîãî ðîçóì³ííÿ îáñÿã³â êîìïåòåíòíîñ-
òåé ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè, âçàºìî-
ä³ÿ ë³êóâàëüíî¿ òà ðåàá³ë³òàö³éíî¿ ñòðàòåã³é ïðîäå-
ìîíñòðîâàíà íà Ìàëþíêó 1 6. ßêùî ïàö³ºíò ³ç
ïåâíèì ñòàíîì çäîðîâ’ÿ íå ìຠâ³äïîâ³äíèõ îáìå-
æåíü ôóíêö³îíóâàííÿ, ë³êóâàííÿ éîãî õâîðîáè º
äîñòàòí³ì äëÿ âèð³øåííÿ ïðîáëåìè. ßêùî ïàö³ºíò
çàçíຠîáìåæåíü æèòòºä³ÿëüíîñò³, ùî ïîâ’ÿçàí³ ç
éîãî ñòàíîì çäîðîâ’ÿ, çàñòîñîâóºòüñÿ ³íàêøà ñòðà-
òåã³ÿ, ñïðÿìîâàíà, â³äïîâ³äíî, íà çìåíøåííÿ îáìå-
æåíü æèòòºä³ÿëüíîñò³ àáî ï³äòðèìêó ôóíêö³îíóâàí-
íÿ. Öÿ ñòðàòåã³ÿ íàçèâàºòüñÿ ðåàá³ë³òàö³éíîþ
ñòðàòå㳺þ3,4. Ó öüîìó âèïàäêó ºäèíå çàñòîñóâàííÿ
ëèøå ë³êóâàëüíèõ ñòðàòåã³é ìîæå íå âèð³øèòè ïðî-
áëåìó, ³ ìîæå çàëèøèòèñÿ ïåâíà ³çîëÿö³ÿ â³ä ñóñ-
ï³ëüñòâà. Äëÿ ÔÐÌ º ñïåöèô³÷íèì ïîºäíàííÿ ë³êó-
âàëüíî¿ ³ ðåàá³ë³òàö³éíî¿ ñòðàòåã³é øëÿõîì
çàñòîñóâàííÿ ìíîæèííèõ ³íòåðâåíö³é, ñïðÿìîâàíèõ
ÿê íà ë³êóâàííÿ ïàòîëî㳿, òàê ³ íà ïîäîëàííÿ îá-
ìåæåíü æèòòºä³ÿëüíîñò³7.
Ïðîòå ë³êóâàííÿ òà ïðîãðàìè ô³çè÷íî¿ òà ðåàá³-
ë³òàö³éíî¿ ìåäèöèíè òàêîæ ìîæóòü â³äíîñèòèñü äî
³íøèõ ñòðàòåã³é îõîðîíè çäîðîâ’ÿ, òàêèõ ÿê ïðîô³-
ëàêòèêà (íàïð. óñêëàäíåíü â³ä çíåðóõîìëåííÿ ÷è
ë³êóâàííÿ, àáî çàõâîðþâàíü, ïîâ’ÿçàíèõ ç â³äñóò-
í³ñòþ ô³çè÷íî¿ àêòèâíîñò³), à òàêîæ ï³äòðèìêà òà
äîãëÿä (íàïð. íàäàííÿ äîïîì³æíèõ ïðèñòðî¿â äëÿ
äîâãîòðèâàëîãî êîðèñòóâàííÿ, ïàë³àòèâíà äîïîìî-
ãà). Ó áàãàòüîõ âèïàäêàõ ö³ âòðó÷àííÿ òà ïðîãðà-
ìè ïîºäíóþòü ö³ ñòðàòå㳿 çàëåæíî â³ä ³íäèâ³äóàëü-
íèõ ïîòðåá ïàö³ºíòà8.
Öåé ðîçä³ë ïåðåâàæíî îïèñóº êë³í³÷íèé ï³äõ³ä
ë³êàð³â ÔÐÌ ³ç çàõâîðþâàííÿì àáî ïîðóøåííÿì,
ÿê â³äïðàâíîþ òî÷êîþ. Ïðîòå ñôåðà êîìïåòåíò-
íîñòåé âêëþ÷ຠîñâ³òó òà íàâ÷àííÿ, òàêîæ, ÿê ³
ìåíåäæìåíò, êîîðäèíàö³þ òà êîíñóëüòàö³¿.
Ñêëàäí³ñòü çàâäàíü ç ðåàá³ë³òàö³¿ ïîêàçàíà íà Ìà-
ëþíêó 29 ³ºðàðõ³÷íîþ ñòðóêòóðîþ ç³ çðîñòàþ÷îþ
¹2(2) *2018
 ÐÎÇÄ²Ë 7 – ÑÔÅÐÀ Ê˲Ͳ×ÍÈÕ ÊÎÌÏÅÒÅÍÒÍÎÑÒÅÉ: ÔÐÌ ÍÀ ÏÐÀÊÒÈÖ²

ñêëàäí³ñòþ (ð³âí³ â³ä I äî V). Ó òîé ÷àñ, ÿê íà

ð³âíÿõ I òà II ïðîâ³äíó çíà÷íó ðîëü â³ä³ãðຠíàéá-
ëèæ÷å ñåðåäîâèùå ³ ïåðâèííà ìåäè÷íà äîïîìîãà,
â á³ëüø ñêëàäíèõ ñèòóàö³ÿõ (ð³âí³ III òà IV) äîïî-
ìîãó íàäàþòü ë³êàð³ ÔÐÌ, ÿê ñàìîñò³éíî, òàê ³ â
ðàìêàõ ìóëüòè-ïðîôåñ³éíî¿ êîìàíäè. Âåðõ³âêà
ï³ðàì³äè îïèñóº âèñîêîñïåö³àë³çîâàí³ ïîñëóãè äëÿ
ïàö³ºíò³â ³ç ñêëàäíèìè ðåàá³ë³òàö³éíèìè ïîòðåáà-
ìè òà ö³ëÿìè òà/àáî ìåíø ïîøèðåíèìè ñòàíàìè
çäîðîâ’ÿ íà ïî÷àòêó ñïåöèô³÷íèõ îáñòàâèí, òà ðå-
àá³ë³òàö³þ ïðè ñòàíàõ çäîðîâ’ÿ (íàïð. ñïèííîìîç-
êîâà òðàâìà, ÷åðåïíî-ìîçêîâà òðàâìà, õðîí³÷íèé Ìàëþíîê 1: Âçàºìî䳿 ë³êóâàëüíî¿ òà ðåàá³ë³òàö³éíî¿ ñòðàòåã³é
áîëüîâèé ñèíäðîì, ë³òí³é â³ê). òà ³íòåãðàòèâíà ðîëü ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
Íà ð³âíÿõ â³ä III äî V ë³êàð³ ÔÐÌ áåçïîñåðåä- (ìîäèô³êîâàíî ç Reinhardt et al.)6
íüî íàäàþòü âòðó÷àííÿ òà ïîñëóãè. Ïðîòå, ë³êàð³
ÔÐÌ ìîæóòü òàêîæ çðîáèòü ñâ³é âíåñîê íà ð³âíÿõ
I òà II, çîêðåìà øëÿõîì íàäàííÿ ïðîñâ³òè ³ íàâ÷àí-
íÿ ³íøèì íàäàâà÷àì ïîñëóã îõîðîíè çäîðîâ’ÿ. ßê
³ â áàãàòüîõ âèïàäêàõ, ìîæóòü çíàäîáèòèñü ð³çí³
ð³âí³ ðåàá³ë³òàö³¿, ³ öåé ïðîöåñ ìຠáóòè êîîðäèíî-
âàíèì. Öÿ êîîðäèíàö³ÿ º îñíîâíîþ êîìïåòåíòí³-
ñòþ ë³êàð³â ÔÐÌ, òà ìîæå áóòè ïîòð³áíîþ äëÿ
îðãàí³çàòîð³â îõîðîíè çäîðîâ’ÿ, â ðàç³ ïîòðåáè â
êîíñóëüòóâàíí³ ¿õ åêñïåðòàìè.

Ïðîöåñ ðåàá³ë³òàö³¿: îö³íþâàííÿ,

âñòàíîâëåííÿ ö³ëåé, âòðó÷àííÿ
³ ô³íàëüíà îö³íêà
ßê çãàäóâàëîñÿ âèùå, ë³êàð³ ÔÐÌ óïðàâëÿþòü, Ìàëþíîê 2: ϳðàì³äà ð³âí³â ñïåö³àë³çàö³¿ ðåàá³ë³òàö³¿, ùî
ïîâ’ÿçàíà ç³ çäîðîâ’ÿì, à òàêîæ ðîëü ë³êàðÿ ô³çè÷íî¿ òà
î÷îëþþòü ³ êîîðäèíóþòü ïðîöåñ ðåàá³ë³òàö³¿ â ðàì- ðåàá³ë³òàö³éíî¿ ìåäèöèíè â íàäàíí³ äîïîìîãè, êîîðäèíàö³¿
êàõ ïðîáëåìíî-îð³ºíòîâàíîãî, ïàö³ºíò-öåíòðè÷íî- ïîñëóã òà îñâ³ò³ ³ íàâ÷àíí³ (ç Gutenbrunner et al9)
ãî òà ö³ë³ñíîãî ï³äõîäó. Çàëåæíî â³ä õàðàêòåðèñ-
òèê òà âèìîã ïàö³ºíòà, ë³êàð³ ÔÐÌ ìîæóòü
âèêîíóâàòè öåé ïðîöåñ ñàìîñò³éíî àáî â êîìàíä³
ôàõ³âö³â ðåàá³ë³òàö³¿. Ïðîöåñ ðåàá³ë³òàö³¿ ïî÷è-
íàºòüñÿ ç ìåäè÷íîãî ä³àãíîçó òà ïðîäîâæóºòüñÿ,
ïîêè ëþäèíà ïîòðåáóº ðåàá³ë³òàö³éíèõ âòðó÷àíü10.
Ïðîöåñ ðåàá³ë³òàö³¿ çàçâè÷àé ñêëàäàºòüñÿ ç 4
ñòàä³é (Ìàëþíîê 3):
– îö³íþâàííÿ,
– âñòàíîâëåííÿ ö³ëåé,
– âòðó÷àííÿ,
– ô³íàëüíà îö³íêà11.
Âîíè ìîæóòü áóòè îïèñàí³ íàñòóïíèì ÷èíîì Ìàëþíîê 3: Ðåàá³ë³òàö³éíèé öèêë (ìîäèô³êîâàíî ç Stucki et al.,
(Âñòàâêà 1): Rauch et al.14)
– Îö³íþâàííÿ: íà ïåðø³é ñòà䳿 âèÿâëÿºòüñÿ íà-
ÿâí³ñòü òà òÿæê³ñòü ïðîáëåì ïàö³ºíòà. Öÿ ³äåí- ñï³ëüíîòè, ô³çè÷íå ñåðåäîâèùå, ïîñëóãè îõîðî-
òèô³êàö³ÿ âêëþ÷ຠîö³íþâàííÿ ôóíêö³îíóâàííÿ, íè çäîðîâ’ÿ òà ³íø³ òîùî), îñîáèñò³ ôàêòîðè
ùî ´ðóíòóºòüñÿ íà ìîäåë³ ÌÊÔ, ³, òàêèì ÷èíîì, (òàê³ ÿê ñïîñ³á æèòòÿ, çâè÷êè, îñâ³òà, ðàñà / åò-
ñòâîðþº ïåðåë³ê ïîðóøåíü ôóíêö³é òà ñòðóêòóð í³÷íà ïðèíàëåæí³ñòü, æèòòºâ³ ïî䳿 àáî ñîö³àëü-
îðãàí³çìó, îáìåæåííÿ àêòèâíîñò³ òà îáìåæåí- íèé ôîí), ïðîãíîñòè÷í³ ôàêòîðè, ðåàá³ë³òàö³éíèé
íÿ ìîæëèâîñò³ ó÷àñò³12. Äîäàòêîâî, ³äåíòèô³êó- ïîòåíö³àë îñîáè òà ¿¿ ïîòðåáè, ïîáàæàííÿ ³ î÷³-
þòüñÿ ôàêòîðè ñåðåäîâèùà (òàê³, ÿê ï³äòðèì- êóâàííÿ. гçí³ ÷ëåíè ìóëüòè-ïðîôåñ³éíî¿ êîìàí-
êà ³ ñòàâëåííÿ ðîäèíè, äðóç³â, ðîáîòîäàâöÿ àáî äè ÔÐÌ, ùî ïðàöþº ñï³ëüíî (ï³ä êåð³âíèöòâîì

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 115
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Âñòàâêà 1. – Êë³í³÷íèé âèïàäîê: çàñòîñóâàííÿ ϳñëÿ ïåð³îäó ðåàá³ë³òàö³éíî¿ ïðîãðàìè ìîæíà îö³íèòè
÷îòèðüîõ ôàç ðåàá³ë³òàö³éíîãî öèêëó ïðîãðåñ òà âèçíà÷èòè ÷åðãîâèé ðåàá³ë³òàö³éíèé öèêë.
Ïàö³ºíò, ùî ñòðàæäຠâ³ä ÷åðåïíî-ìîçêîâî¿ òðàâìè, íà-
ä³éøîâ äî ðåàá³ë³òàö³éíîãî â³ää³ëåííÿ, ùîá ðîçïî÷àòè ðåàá³ë³- Ɉɰɿɧɤɚ ɩɪɨɝɪɟɫɭ
òàö³éíó ïðîãðàìó. Ïåðøèì êðîêîì ðåàá³ë³òàö³éíîãî öèêëó º Ȼɚɡɨɜɚ ɨɰɿɧɤɚ ɩɿɫɥɹ ɩɟɜɧɨɝɨ
îö³íþâàííÿ, ñïðÿìîâàíå íà âèçíà÷åííÿ ïðîáëåìè, ÿêà ïîâ’ÿçà- ɩɟɪɿɨɞɭ
íà ç îáìåæåííÿì æèòòºä³ÿëüíîñò³. Ìè ìîæåìî âèçíà÷èòè ÷àñò- ȼɚɠɤɿɫɬɶ ȼɚɠɤɿɫɬɶ
êîâó âòðàòó ñèëè ì’ÿç³â ó 4 ê³íö³âêàõ (b730.2), ó íüîãî ïîðó- b140 Ɏɭɧɤɰɿʀ ɭɜɚɝɢ 2 1
øåíà óâàãà (b140.2) ³ º ñåðéîçí³ ïîðóøåííÿ ïàì’ÿò³ (b144.3). b144 Ɏɭɧɤɰɿʀ ɩɚɦ’ɹɬɿ 3 3
³í âêàçóº íà á³ëü ïðè ðóõàõ ïðàâîãî ñòåãíà. Ö³ ïîðóøåííÿ b280 ȼɿɞɱɭɬɬɹ ɛɨɥɸ 3 1
ïðèçâîäÿòü äî çíèæåííÿ çäàòíîñò³ îòðèìàííÿ ³íôîðìàö³¿, ÿêà b710 Ɏɭɧɤɰɿʀ ɪɭɯɥɢɜɨɫɬɿ 2
çà äîïîìîãîþ ñïðèÿííÿ îñ³á òà òåõíîëîã³é ìîæå äàòè õîðîøå ɫɭɝɥɨɛɭ
âèêîíàííÿ (d132.23). ²ñíóþòü ïðîáëåìè â Çì³í³ òà ï³äòðèìö³ b730 Ɏɭɧɤɰɿʀ ɦ’ɹɡɨɜɨʀ ɫɢɥɢ 2 1
ïîëîæåíü ò³ëà (d410 – d429), Íåñåíí³, ïåðåì³ùåíí³ òà êîðèñòó- b735 Ɏɭɧɤɰɿʀ ɬɨɧɭɫɭ ɦ’ɹɡɿɜ 2 1
âàíí³ îá’ºêòàìè (d430 – d449), Õîäüá³ òà ïåðåñóâàíí³ (d450 – b740 Ɏɭɧɤɰɿʀ ɦ’ɹɡɨɜɨʀ 3 2
d469), Ìèòò³, ùî äîáðå âèêîíóºòüñÿ ç äîïîìîãîþ (d510.12) ɜɢɬɪɢɜɚɥɨɫɬɿ
Äðóãèé êðîê – öå ïðèçíà÷åííÿ ôàõ³âö³â îõîðîíè çäîðîâ’ÿ – b750 Ɏɭɧɤɰɿʀ ɪɭɯɨɜɢɯ 2 1
ɪɟɮɥɟɤɫɿɜ
÷ëåí³â êîìàíäè äëÿ âèð³øåííÿ ïðîáëåì. Òðåòÿ ôàçà – öå òèï
b770 Ɏɭɧɤɰɿʀ ɩɚɬɟɪɧɭ 3 2
âòðó÷àííÿ. ˳êàð ÔÐÌ êîîðäèíóº ö³ ôàçè, îáãîâîðþþ÷è ç
ɯɨɞɶɛɢ
êîìàíäîþ ïð³îðèòåòè âòðó÷àíü òà ö³ëü ìîäèô³êàö³¿.
Ɂɞɚɬ- ȼɢɤɨ- Ɂɞɚɬ- ȼɢɤɨ-
ϳäñóìîê öèõ òðüîõ ôàç íàâåäåíèé íèæ÷å.
ɧɿɫɬɶ ɧɚɧɧɹ ɧɿɫɬɶ ɧɚɧɧɹ
ɉɭɧɤɬ ɆɄɎ ȼɚɠɤɿɫɬɶ ɉɪɢɡɧɚɱɟɧɧɹ ȼɬɪɭɱɚɧɧɹ d132 Ɉɬɪɢɦɚɧɧɹ ɿɧɮɨɪɦɚɰɿʀ 3 2 3 1
b140 Ɏɭɧɤɰɿʀ ɭɜɚɝɢ 2 ɇɟɣɪɨɩɫɢɯɨɥɨɝ Ɍɪɟɧɭɜɚɧɧɹ d410 Ɂɦɿɧɚ ɨɫɧɨɜɧɢɯ 2 1 1 0
Ʌɿɤɚɪ ɎɊɆ ɭɜɚɝɢ, ɩɨɥɨɠɟɧɶ ɬɿɥɚ
ɚɦɚɧɬɚɞɢɧ d415 ɉɿɞɬɪɢɦɚɧɧɹ 2 1 1 0
b144 Ɏɭɧɤɰɿʀ ɩɚɦ’ɹɬɿ 3 ɇɟɣɪɨɩɫɢɯɨɥɨɝ ɩɨɥɨɠɟɧɧɹ ɬɿɥɚ
b280 ȼɿɞɱɭɬɬɹ ɛɨɥɸ 3 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ, d420 ɉɟɪɟɦɿɳɟɧɧɹ 2 1 1 0
ɬɟɪɚɩɟɜɬ ɚɧɚɥɶɝɟɬɢɤ d440 Ⱦɪɿɛɧɚ ɦɨɬɨɪɢɤɚ ɤɢɫɬɿ 3 3 3 2
Ʌɿɤɚɪ ɎɊɆ d445 ȼɢɤɨɪɢɫɬɚɧɧɹ ɤɢɫɬɿ ɬɚ 2 2 2 1
b710 Ɏɭɧɤɰɿʀ 2 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ ɪɭɤɢ
ɪɭɯɥɢɜɨɫɬɿ ɫɭɝɥɨɛɭ ɬɟɪɚɩɟɜɬ d450 ɏɨɞɶɛɚ 3 1 2 1
b730 Ɏɭɧɤɰɿʀ ɦ’ɹɡɨɜɨʀ 2 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ
ɫɢɥɢ ɬɟɪɚɩɟɜɬ d455 ɉɟɪɟɦɿɳɟɧɧɹ ɭ ɫɩɨɫɿɛ, 4 3 3 2
b735 Ɏɭɧɤɰɿʀ ɬɨɧɭɫɭ 2 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ, ɹɤɢɣ ɜɿɞɪɿɡɧɹɽɬɶɫɹ ɜɿɞ
ɦ’ɹɡɿɜ ɬɟɪɚɩɟɜɬ ɚɧɬɢɫɩɚɫɬɢɱɧɿ ɯɨɞɶɛɢ
Ʌɿɤɚɪ ɎɊɆ ɩɪɟɩɚɪɚɬɢ d510 Ɇɢɬɬɹ 1 0 0 0
b740 Ɏɭɧɤɰɿʀ ɦ’ɹɡɨɜɨʀ 3 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ d520 Ⱦɨɝɥɹɞ ɡɚ ɱɚɫɬɢɧɚɦɢ 1 0 0 0
ɜɢɬɪɢɜɚɥɨɫɬɿ ɬɟɪɚɩɟɜɬ ɬɿɥɚ
b750 Ɏɭɧɤɰɿʀ ɪɭɯɨɜɢɯ 2 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ, d530 Ʉɨɪɢɫɬɭɜɚɧɧɹ ɬɭɚɥɟɬɨɦ 1 0 1 0
ɪɟɮɥɟɤɫɿɜ ɬɟɪɚɩɟɜɬ ɚɧɬɢɫɩɚɫɬɢɱɧɿ d540 Ʉɨɪɢɫɬɭɜɚɧɧɹ ɨɞɹɝɨɦ 2 1 1 0
Ʌɿɤɚɪ ɎɊɆ ɩɪɟɩɚɪɚɬɢ ɬɚ ɜɡɭɬɬɹɦ
b770 Ɏɭɧɤɰɿʀ ɩɚɬɟɪɧɭ 3 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ, d550 ȼɠɢɜɚɧɧɹ ʀɠɿ 1 1 1 0
ɯɨɞɶɛɢ ɬɟɪɚɩɟɜɬ ɚɧɬɢɫɩɚɫɬɢɱɧɿ
d560 ɉɢɬɬɹ 2 2 1 1
Ʌɿɤɚɪ ɎɊɆ ɩɪɟɩɚɪɚɬɢ
Ɂɞɚɬɧɿɫɬɶ ȼɢɤɨɧɚɧɧɹ
d132 Ɉɬɪɢɦɚɧɧɹ 3 2 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ
ɿɧɮɨɪɦɚɰɿʀ ɬɟɪɚɩɟɜɬ ë³êàðÿ ÔÐÌ) ìîæóòü çðîáèòè ñâ³é âíåñîê äî ö³º¿
d410 Ɂɦɿɧɚ ɨɫɧɨɜɧɢɯ 2 1 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ
ɩɨɥɨɠɟɧɶ ɬɿɥɚ ɬɟɪɚɩɟɜɬ ñòà䳿 îö³íþâàííÿ ç ¿õ êîíêðåòíèìè ïðîôåñ³éíè-
d415 ɉɿɞɬɪɢɦɚɧɧɹ 2 1 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ ìè çíàííÿìè ïðî îñîáó ³ éîãî/¿¿ ôóíêö³îíóâàííÿ
ɩɨɥɨɠɟɧɧɹ ɬɿɥɚ ɬɟɪɚɩɟɜɬ
d420 ɉɟɪɟɦɿɳɟɧɧɹ 2 1 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ
(Òàáëèöÿ ²).
ɬɟɪɚɩɟɜɬ – âñòàíîâëåííÿ ö³ëåé: ç óðàõóâàííÿì ïðîáëåì
d440 Ⱦɪɿɛɧɚ ɦɨɬɨɪɢɤɚ 3 3 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ, òà ïîòåíö³àëó, âèÿâëåíèõ íà ñòà䳿 îö³íþâàííÿ, ïðî-
ɤɢɫɬɿ ɬɟɪɚɩɟɜɬ ɬɪɟɧɭɜɚɧɧɹ
ȿɪɝɨɬɟɪɚɩɟɜɬ òÿãîì ñòà䳿 âñòàíîâëåííÿ ö³ëåé ñòâîðþºòüñÿ ðåàá³-
d445 ȼɢɤɨɪɢɫɬɚɧɧɹ 2 2 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ, ë³òàö³éíèé ïëàí, ñïåöèô³÷íèé äëÿ êîíêðåòíî¿ îñîáè.
ɤɢɫɬɿ ɬɚ ɪɭɤɢ ɬɟɪɚɩɟɜɬ ɬɪɟɧɭɜɚɧɧɹ
ȿɪɝɨɬɟɪɚɩɟɜɬ Öåé ïëàí âêëþ÷ຠêîðîòêîñòðîêîâ³ òà äîâãîñòðîêîâ³
d450 ɏɨɞɶɛɚ 3 1 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ ö³ë³ äëÿ ïàö³ºíòà, ³ ïðîïîíóº ÷àñîâ³ òåðì³íè, ïðîòÿãîì
ɬɟɪɚɩɟɜɬ
d455 ɉɟɪɟɦɿɳɟɧɧɹ 4 3 Ɏɿɡɢɱɧɢɣ ȼɩɪɚɜɢ ÿêèõ âîíè ïîâèíí³ áóòè äîñÿãíåí³. Ïåðøîðÿäíèì
ɭ ɫɩɨɫɿɛ, ɹɤɢɣ ɬɟɪɚɩɟɜɬ çíà÷åííÿì äëÿ âñòàíîâëåííÿ ðåàë³ñòè÷íèõ òà äî-
ɜɿɞɪɿɡɧɹɽɬɶɫɹ ɜɿɞ ɯɨɞɶɛɢ ñÿæíèõ ö³ëåé º çàëó÷åííÿ ïàö³ºíòà òà ðîäèíè/äîãëÿ-
d510 Ɇɢɬɬɹ 1 0 ȿɪɝɨɬɟɪɚɩɟɜɬ ȼɩɪɚɜɢ
d520 Ⱦɨɝɥɹɞ ɡɚ 1 0 ȿɪɝɨɬɟɪɚɩɟɜɬ ȼɩɪɚɜɢ äà÷³â âïðîäîâæ ñòà䳿 âñòàíîâëåííÿ ö³ëåé. Öÿ ñòà-
ɱɚɫɬɢɧɚɦɢ ɬɿɥɚ ä³ÿ âêëþ÷ຠòàêîæ ïðèçíà÷åííÿ êîíêðåòíèõ
d530 Ʉɨɪɢɫɬɭɜɚɧɧɹ 1 0 ȿɪɝɨɬɟɪɚɩɟɜɬ ȼɩɪɚɜɢ
ɬɭɚɥɟɬɨɦ âòðó÷àíü â³äïîâ³äíî äî âñòàíîâëåíèõ ö³ëåé òà, çãî-
d540 Ʉɨɪɢɫɬɭɜɚɧɧɹ 2 0 ȿɪɝɨɬɟɪɚɩɟɜɬ ȼɩɪɚɜɢ äîì, ³ â³äïîâ³äàëüíîãî ÷ëåíà(-³â) ìóëüòè-ïðîôåñ³é-
ɨɞɹɝɨɦ ɬɚ ɜɡɭɬɬɹɦ
d550 ȼɠɢɜɚɧɧɹ ʀɠɿ 1 0 Ɍɟɪɚɩɟɜɬ ɦɨɜɢ ȼɩɪɚɜɢ íî¿ êîìàíäè ÔÐÌ (çà êåð³âíèöòâîì ë³êàðÿ ÔÐÌ) äëÿ
ɬɚ ɦɨɜɥɟɧɧɹ ïðîâåäåííÿ ³íòåðâåíö³é13. Âèá³ð âòðó÷àíü çíà÷íî
d560 ɉɢɬɬɹ 2 0 Ɍɟɪɚɩɟɜɬ ɦɨɜɢ ȼɩɪɚɜɢ
ɬɚ ɦɨɜɥɟɧɧɹ ïîëåãøóºòüñÿ ç âèêîðèñòàííÿì ìîäåë³ ÌÊÔ14.

116 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 7 – ÑÔÅÐÀ Ê˲Ͳ×ÍÈÕ ÊÎÌÏÅÒÅÍÒÍÎÑÒÅÉ: ÔÐÌ ÍÀ ÏÐÀÊÒÈÖ²
– Âòðó÷àííÿ: íà ñòà䳿 âòðó÷àíü çä³éñíþþòüñÿ óñ³
òåðàïåâòè÷í³, íàâ÷àëüí³ òà äîïîì³æí³ ³íòåð-
âåíö³¿, çàçíà÷åí³ â ðåàá³ë³òàö³éíîìó ïëàí³ â³äïî-
â³äíî äî âñòàíîâëåíèõ ö³ëåé (äèâ. íèæ÷å).
Âòðó÷àííÿ ïîâèíí³ áóòè ñïðÿìîâàí³ íà çàïîá³-
ãàííÿ, ñòàá³ë³çàö³þ, ïîêðàùåííÿ ÷è â³äíîâëåí-
íÿ ïîðóøåíü ôóíêö³é òà ñòðóêòóð îðãàí³çìó,
à òàêîæ íà îïòèì³çàö³þ àêòèâíîñò³ òà ó÷àñò³,
çâàæàþ÷è íà çäàòí³ñòü òà âèêîíàííÿ ëþäèíè,
à òàêîæ â³äïîâ³äíå ñåðåäîâèùå4.
– Ô³íàëüíà îö³íêà: íàðåøò³, îö³íþþòüñÿ ðåçóëü-
òàòè ïðîãðàì âòðó÷àííÿ ïîð³âíÿëüíî ç ïîñòàâ-
ëåíèìè ö³ëÿìè. ²íøèìè ñëîâàìè, îö³íêà ðåçóëü-
òàò³â ïðîâîäèòüñÿ ç ìåòîþ îö³íêè ð³âíÿ
äîñÿãíåííÿ ö³ëåé. Íà öüîìó åòàï³ êîìàíäà
ÔÐÌ ïîâèííà âèçíà÷èòè, ÷è ùå ³ñíóþòü íåâè-
ð³øåí³, àëå ðîçâ’ÿçí³ ïðîáëåìè, ïðè íàÿâíîñò³
ÿêèõ ïðîöåñ ðåàá³ë³òàö³¿ ñë³ä ïðîäîâæóâàòè. Äëÿ
öüîãî ïðîâîäèòüñÿ ïåðåãëÿä òà ïåðåïëàíóâàí-
 ïðîãðàìè ÔÐÌ â³äïîâ³äíî äî íîâî¿
íÿ ³ñíóþ÷î¿
Òàáëèöÿ ²: Ïðèêëàäè äåÿêèõ ïðîáëåì, ùî ðîçãëÿäàþòüñÿ ó ðåàá³ë³òàö³éíîìó ïëàí³
ɉɪɨɛɥɟɦɚ ɐɿɥɶ
ɉɨɪɭɲɟɧɧɹ ɮɭɧɤɰɿɣ ɬɚ ɫɬɪɭɤɬɭɪ ɨɪɝɚɧɿɡɦɭ
Ȼɿɥɶ Ɂɦɟɧɲɟɧɧɹ ɛɨɥɸ
ɋɥɚɛɤɿɫɬɶ ɦ’ɹɡɿɜ Ɂɛɿɥɶɲɟɧɧɹ ɫɢɥɢ ɦ’ɹɡɿɜ
Ⱥɮɚɡɿɹ Ⱦɟɬɚɥɶɧɟ ɨɰɿɧɸɜɚɧɧɹ ɮɭɧɤɰɿɣ ɦɨɜɥɟɧɧɹ ɬɚ ɦɨɜɢ,
ɫɩɪɢɹɧɧɹ ɮɭɧɤɰɿɹɦ ɦɨɜɥɟɧɧɹ ɬɚ ɦɨɜɢ.
Ⱦɟɩɪɟɫɿɹ Ɇɟɧɟɞɠɦɟɧɬ ɞɟɩɪɟɫɿʀ, ɧɨɪɦɚɥɿɡɚɰɿɹ ɬɚ ɦɨɧɿɬɨɪɢɧɝ
ɩɨɪɭɲɟɧɶ ɧɚɫɬɪɨɸ ɞɥɹ ɩɨɤɪɚɳɟɧɧɹ ɭɱɚɫɬɿ
ɭ ɫɟɫɿɹɯ ɡ ɮɿɡɢɱɧɨʀ ɬɟɪɚɩɿʀ ɬɚ ɟɪɝɨɬɟɪɚɩɿʀ
Ⱦɢɫɮɭɧɤɰɿɹ Ⱦɿɚɝɧɨɫɬɢɱɧɟ ɨɰɿɧɸɜɚɧɧɹ ɬɚ ɬɟɫɬɭɜɚɧɧɹ ɮɭɧɤɰɿʀ
ɫɟɱɨɜɢɞɿɥɟɧɧɹ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ ɬɚ ɤɢɲɤɿɜɧɢɤɚ (ɧɚɩɪ. ɮɿɡɢɤɚɥɶɧɟ
ɬɚ ɜɢɩɨɪɨɠɧɟɧɧɹ ɨɛɫɬɟɠɟɧɧɹ, ɳɨɞɟɧɧɢɤɢ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ
ɤɢɲɤɿɜɧɢɤɚ, ɫɢɧɞɪɨɦ ɬɚ ɤɢɲɤɿɜɧɢɤɚ, ɚɧɚɥɿɡ ɫɿɱɿ, ɭɪɨɤɭɥɶɬɭɪɚ,
ɛɨɥɸ ɬɚɡɨɜɨɝɨ ɞɧɚ ɭɥɶɬɪɚɡɜɭɤɨɜɟ ɞɨɫɥɿɞɠɟɧɧɹ ɫɟɱɨɜɢɜɿɞɧɢɯ ɲɥɹɯɿɜ,
ɭɪɨɞɢɧɚɦɢɱɧɿ ɬɟɫɬɢ, ɧɟɣɪɨɮɿɡɿɨɥɨɝɿɱɧɿ ɬɟɫɬɢ),
ɫɩɪɢɹɧɧɹ ɫɚɦɨɫɬɿɣɧɨɫɬɿ ɜ ɤɨɧɬɪɨɥɿ ɡɚ ɫɟɱɨɜɢɦ
ɦɿɯɭɪɨɦ ɬɚ ɤɢɲɤɿɜɧɢɤɨɦ, ɫɩɪɢɹɧɧɹ ɤɟɪɭɜɚɧɧɸ
ɯɪɨɧɿɱɧɢɦ ɛɨɥɶɨɜɢɦ ɫɢɧɞɪɨɦɨɦ ɬɚɡɨɜɨɝɨ ɞɧɚ
Ɉɛɦɟɠɟɧɧɹ ɚɤɬɢɜɧɨɫɬɿ ɬɚ ɨɛɦɟɠɟɧɧɹ ɦɨɠɥɢɜɨɫɬɿ ɭɱɚɫɬɿ
Ɍɪɭɞɧɨɳɿ ɜ ɤɨɪɢɫɬɭ- ɋɩɪɢɹɧɧɹ ɬɚ ɡɚɛɟɡɩɟɱɟɧɧɹ ɧɟɡɚɥɟɠɧɨɫɬɿ
ɜɚɧɧɿ ɨɞɹɝɨɦ ɬɚ ɜɡɭɬɬɹɦ ɜ ɚɤɬɢɜɧɨɫɬɹɯ ɡ ɫɚɦɨɨɛɫɥɭɝɨɜɭɜɚɧɧɹ
ɬɚ ɜ ɤɨɪɢɫɬɭɜɚɧɧɿ
ɬɭɚɥɟɬɨɦ
Ɍɪɭɞɧɨɳɿ ɩɪɢ ɯɨɞɶɛɿ ɋɩɪɢɹɧɧɹ ɬɚ ɡɚɛɟɡɩɟɱɟɧɧɹ ɧɟɡɚɥɟɠɧɨɫɬɿ
ɩɪɢ ɯɨɞɶɛɿ
ɇɟɦɨɠɥɢɜɿɫɬɶ Ɉɰɿɧɸɜɚɧɧɹ ɡɞɚɬɧɨɫɬɿ ɬɚ ɜɢɤɨɧɚɧɧɹ ɨɫɨɛɨɸ
ɤɟɪɭɜɚɬɢ ɞɨɦɚɲɧɿɦɢ ɞɨɦɚɲɧɿɯ ɚɤɬɢɜɧɨɫɬɟɣ; ɫɩɪɢɹɧɧɹ ɬɚ ɡɚɛɟɡɩɟɱɟɧɧɹ ɧɹ ɬɚ ɩɪɢɝɨɬɭɜɚɧɧɹ ʀɠɿ, ɦɢɬɬɹ, ɱɢɳɟɧɧɹ ɬɨɳɨ);
ɫɩɪɚɜɚɦɢ ɧɟɡɚɥɟɠɧɨɫɬɿ ɭ ɞɨɦɚɲɧɿɯ ɚɤɬɢɜɧɨɫɬɹɯ.
ȼɬɪɚɬɚ ɪɨɛɨɬɢ ɉɨɜɟɪɧɟɧɧɹ ɞɨ ɪɨɛɨɬɢ
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ö³ë³ àáî, ÿêùî ïðîöåñ ðåàá³ë³òàö³¿ áóäå çàâåðøå-
íî11. Öåé ïðîöåñ º ïîâòîðþâàíèì, ³ ÿêùî çàëè-
øàþòüñÿ ïðîáëåìè/ïèòàííÿ, ùî ïîòðåáóþòü
âòðó÷àííÿ, öèêë ïðîäîâæóºòüñÿ äî äîñÿãíåííÿ
ö³ëåé (Ìàëþíîê 1). Ïðîòÿãîì á³ëüøîñò³ ñòàä³é
ðåàá³ë³òàö³éíîãî ïðîöåñó êîìàíäà ÔÐÌ âèêîðè-
ñòîâóº ð³çí³ ³íñòðóìåíòè îö³íþâàííÿ, äëÿ âñòà-
íîâëåííÿ íàÿâíîñò³ òà ñòóïåíÿ âàæêîñò³ ïðî-
áëåì, ³íôîðìóâàííÿ ïðî ïëàíóâàííÿ ³íòåðâåíö³é,
ìîí³òîðóâàííÿ ïðîãðåñó, ïðîãíîçóâàííÿ â³äíîâ-
ëåííÿ òà ïëàíóâàííÿ âèïèñêè15. Âèêîðèñòàííÿ
ñòàíäàðòíèõ ³íñòðóìåíò³â îö³íþâàííÿ (âèì³ðþ-
âàííÿ ðåçóëüòàò³â) â ìåæàõ ïðîöåäóðè îö³íþ-
âàííÿ íà îñíîâ³ ÌÊÔ ï³äâèùóº êîìóí³êàö³þ ì³æ
÷ëåíàìè êîìàíäè. Íàïðèê³íö³ ðåàá³ë³òàö³éíîãî
ïðîöåñó ïàö³ºíò òà éîãî/¿¿ ðîäèíà/äîãëÿäà÷ ïî-
âèíí³ áóòè ïî³íôîðìîâàí³ ïðî ïîäàëüøó
ï³äòðèìêó çäîðîâ’ÿ, ïîäàëüø³ ñïîñòåðåæí³ â³çè-
òè, ÿêùî íåîáõ³äíî, òà ñïîñîáè ïîâòîðíîãî äî-
ñòóïó äî ïîñëóã.
Ɇɨɠɥɢɜɿ ɜɬɪɭɱɚɧɧɹ
Ʌɿɤɢ-ɚɧɚɥɶɝɟɬɢɤɢ; ɮɿɡɿɨɬɟɪɚɩɟɜɬɢɱɧɿ
ɦɨɞɚɥɶɧɨɫɬɿ; ɭɩɪɚɜɥɿɧɧɹ ɫɬɪɟɫɨɦ; ɩɨɥɿɩɲɟɧɧɹ
ɫɬɪɚɬɟɝɿɣ ɩɨɞɨɥɚɧɧɹ ɬɚ ɿɧɲɢɯ ɫɬɪɚɬɟɝɿɣ
ȼɩɪɚɜɢ ɧɚ ɩɨɫɢɥɟɧɧɹ; ɟɥɟɤɬɪɢɱɧɚ ɫɬɢɦɭɥɹɰɿɹ
ɞɥɹ ɩɨɫɢɥɟɧɧɹ ɦ’ɹɡɿɜ
Ɍɪɟɧɭɜɚɧɧɹ ɦɨɜɥɟɧɧɹ ɬɚ ɦɨɜɢ
Ⱥɧɬɢɞɟɩɪɟɫɚɧɬɢ ɜɿɞ ɞɟɩɪɟɫɿʀ; ɩɫɢɯɨɬɟɪɚɩɿɹ;
ɤɨɝɧɿɬɢɜɧɚ ɬɚ ɩɨɜɟɞɿɧɤɨɜɚ ɬɟɪɚɩɿɹ;
ɤɨɧɫɭɥɶɬɭɜɚɧɧɹ
Ɋɟɬɪɟɧɭɜɚɧɧɹ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ ɬɚ ɤɢɲɤɿɜɧɢɤɚ;
ɜɩɪɚɜɢ ɞɥɹ ɬɚɡɨɜɨɝɨ ɞɧɚ ɞɥɹ ɡɦɿɰɧɟɧɧɹ
ɬɚ ɪɨɡɫɥɚɛɥɟɧɧɹ ɦ’ɹɡɿɜ; ȯɆȽ ɚɛɨ ɛɿɨɥɨɝɿɱɧɢɣ
ɡɜɨɪɨɬɧɢɣ ɡɜ’ɹɡɨɤ ɡ ɬɢɫɤɨɦ; ɦɟɞɢɤɚɦɟɧɬɨɡɧɚ
ɬɟɪɚɩɿɹ; ɩɟɪɟɦɿɠɧɚ ɤɚɬɟɬɟɪɢɡɚɰɿɹ; ɟɥɟɤɬɪɢɱɧɚ
ɫɬɢɦɭɥɹɰɿɹ ɞɥɹ ɡɦɿɰɧɟɧɧɹ ɦ’ɹɡɿɜ ɬɚɡɨɜɨɝɨ ɞɧɚ
ɬɚ ɦɨɞɭɥɸɜɚɧɧɹ ɛɨɥɸ; ɟɥɟɤɬɪɢɱɧɚ ɫɬɢɦɭɥɹɰɿɹ
ɞɥɹ ɤɨɧɬɪɨɥɸ ɡɚ ɝɿɩɟɪ- ɬɚ ɝɿɩɨɮɭɧɤɰɿɽɸ
ɞɟɬɪɭɡɨɪɭ;
Ɍɪɟɧɭɜɚɧɧɹ ɛɚɥɚɧɫɭ, ɬɪɚɧɫɮɟɪɿɜ ɬɚ ɦɨɛɿɥɶɧɨɫɬɿ;
ɫɩɟɰɢɮɿɱɧɟ ɡɚɜɞɚɧɧɹ ɞɨ ɬɪɟɧɭɜɚɧɧɹ ɞɥɹ ɤɨɪɢɫ-
ɬɭɜɚɧɧɹ ɨɞɟɠɟɸ, ɜɡɭɬɬɹɦ ɬɚ ɬɭɚɥɟɬɨɦ; ɩɪɢɫɬɨ-
ɫɭɜɚɧɧɹ ɫɟɪɟɞɨɜɢɳɚ ɞɥɹ ɤɨɪɢɫɬɭɜɚɧɧɹ ɬɭɚɥɟɬɨɦ
Ɍɪɟɧɭɜɚɧɧɹ ɛɚɥɚɧɫɭ, ɬɪɚɧɫɮɟɪɿɜ ɬɚ ɦɨɛɿɥɶɧɨɫɬɿ;
ɩɪɢɡɧɚɱɟɧɧɹ, ɬɪɟɧɭɜɚɧɧɹ ɬɚ ɧɚɝɥɹɞ ɡɚ ɤɨɪɢɫɬɭ-
ɜɚɧɧɹɦ ɞɨɩɨɦɿɠɧɢɦ ɩɪɢɫɬɪɨɽɦ ɞɥɹ ɯɨɞɶɛɢ
Ɍɪɟɧɭɜɚɧɧɹ ɞɨɦɚɲɧɿɯ ɚɤɬɢɜɧɨɫɬɟɣ (ɩɿɞɝɨɬɭɜɚɧ-
ɫɩɪɢɹɧɧɹ ɦɨɠɥɢɜɨɫɬɹɦ ɜɢɤɨɪɢɫɬɚɧɧɹ
ɚɥɶɬɟɪɧɚɬɢɜɧɢɯ ɦɟɬɨɞɿɜ ɚɛɨ ɞɠɟɪɟɥ ɬɚ/ɚɛɨ
ɞɨɩɨɦɿɠɧɨɝɨ ɨɛɥɚɞɧɚɧɧɹ; ɚɞɚɩɬɚɰɿɹ ɛɭɞɢɧɤɭ
ɬɚ ɿɧɲɚ ɚɞɚɩɬɚɰɿɹ ɫɟɪɟɞɨɜɢɳɚ
Ɉɰɿɧɤɚ ɩɪɨɮɟɫɿɣɧɨʀ ɡɞɚɬɧɨɫɬɿ ɨɫɨɛɢ ɬɚ ɦɿɫɰɹ
ɪɨɛɨɬɢ; ɜɿɞɧɨɜɥɟɧɧɹ ɩɪɨɮɟɫɿɣɧɢɯ ɡɞɿɛɧɨɫɬɟɣ;
ɚɞɚɩɬɚɰɿɹ ɩɪɨɮɟɫɿʀ; ɩɪɨɮɟɫɿɣɧɚ ɩɟɪɟɩɿɞɝɨɬɨɜɤɚ;
ɚɞɚɩɬɚɰɿɹ ɪɨɛɨɱɨɝɨ ɦɿɫɰɹ ɬɚ ɨɛɥɚɞɧɚɧɧɹ;
ɜɞɨɫɤɨɧɚɥɟɧɧɹ ɞɨɫɬɭɩɭ ɬɚ ɩɿɞɬɪɢɦɤɢ ɧɚ ɪɨɛɨɬɿ
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Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Òàáëèöÿ ²². Ñòàíè, ÿê³ ë³êàð³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè ë³êóþòü àáî äî ÿêèõ ìîæóòü áóòè äîëó÷åí³ (ïîâíèé ïåðåë³ê
ìîæëèâî çíàéòè ó Äîäàòêó 2.)

• Ɍɪɚɜɦɚɬɢɱɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ, ɧɚɩɪ. ɱɟɪɟɩɧɨ-ɦɨɡɤɨɜɚ ɬɪɚɜɦɚ, ɫɩɢɧɧɨɦɨɡɤɨɜɚ ɬɪɚɜɦɚ, ɫɩɨɥɭɱɟɧɚ ɬɪɚɜɦɚ, ɩɨɲɤɨɞɠɟɧɧɹ
ɩɟɪɢɮɟɪɢɱɧɢɯ ɧɟɪɜɿɜ ɿ ɫɩɥɟɬɿɧɶ, ɫɩɨɪɬɢɜɧɿ ɬɪɚɜɦɢ/ɩɨɲɤɨɞɠɟɧɧɹ, ɜɢɪɨɛɧɢɱɚ ɬɪɚɜɦɚ, ɩɟɪɟɥɨɦɢ ɤɿɫɬɨɤ, ɬɪɚɜɦɚɬɢɱɧɢɣ ɪɨɡɪɢɜ
ɫɭɯɨɠɢɥɤɿɜ ɚɛɨ ɡɜ'ɹɡɨɤ, ɨɩɿɤɨɜɚ ɬɪɚɜɦɚ ɬɚ ɧɚɫɥɿɞɤɢ ɯɿɪɭɪɝɿɱɧɢɯ ɨɩɟɪɚɰɿʀ ɬɚ ɿɧɲɢɯ ɜɢɞɿɜ ɥɿɤɭɜɚɧɧɹ (ɧɚɩɪ. ɚɦɩɭɬɚɰɿɹ ɤɿɧɰɿɜɨɤ,
ɤɨɧɬɪɚɤɬɭɪɢ, ɩɨɜ'ɹɡɚɧɿ ɡ ɪɚɞɿɚɰɿɣɧɢɦ ɭɪɚɠɟɧɧɹɦ).
• ɇɟɬɪɚɜɦɚɬɢɱɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ ɧɟɪɜɨɜɨʀ ɫɢɫɬɟɦɢ: ɧɚɩɪ. ɿɧɫɭɥɶɬ, ɟɤɫɬɪɚɩɿɪɚɦɿɞɧɿ ɬɚ ɪɭɯɨɜɿ ɪɨɡɥɚɞɢ, ɜɤɥɸɱɧɨ ɡ ɯɜɨɪɨɛɨɸ
ɉɚɪɤɿɧɫɨɧɚ, ɞɢɫɬɨɧɿɹɦɢ, ɦɧɨɠɢɧɧɢɦ ɫɤɥɟɪɨɡɨɦ, ɿɧɮɟɤɰɿʀ (ɜɤɥɸɱɧɨ ɡ ɩɨɥɿɨɦɿɽɥɿɬɨɦ) ɬɚ ɩɭɯɥɢɧɢ ɐɇɋ, ɫɤɥɚɞɧɿ ɧɚɫɥɿɞɤɢ
ɧɟɣɪɨɯɿɪɭɪɝɿɱɧɢɯ ɜɬɪɭɱɚɧɶ, ɦ'ɹɡɨɜɚ ɞɢɫɬɪɨɮɿɹ ɬɚ ɧɟɪɜɨɜɨ-ɦ'ɹɡɨɜɿ ɪɨɡɥɚɞɢ, ɫɢɫɬɟɦɧɿ ɚɬɪɨɮɿʀ, ɳɨ ɭɪɚɠɭɸɬɶ ɐɇɋ (ɧɚɩɪ.
ɚɬɚɤɫɿʀ, ɫɩɿɧɚɥɶɧɿ ɦ'ɹɡɨɜɿ ɚɬɪɨɮɿʀ, ɯɜɨɪɨɛɢ ɦɨɬɨɧɟɣɪɨɧɭ, ɜɤɥɸɱɚɸɱɢ ɛɿɱɧɢɣ ɚɦɿɨɬɪɨɮɿɱɧɢɣ ɫɤɥɟɪɨɡ, ɩɨɫɬ-ɩɨɥɿɨɦɿɽɥɿɬɧɢɣ
ɫɢɧɞɪɨɦ), ɿɧɲɿ ɞɟɝɟɧɟɪɚɬɢɜɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ ɧɟɪɜɨɜɨʀ ɫɢɫɬɟɦɢ (ɧɚɩɪ. ɯɜɨɪɨɛɚ Ⱥɥɶɰɝɟɣɦɟɪɚ).
• Ƚɨɫɬɪɢɣ ɚɛɨ ɯɪɨɧɿɱɧɢɣ ɛɿɥɶ ɜɧɚɫɥɿɞɨɤ ɪɿɡɧɢɯ ɩɪɢɱɢɧ: ɬɚɤɢɯ ɹɤ ɚɦɩɭɬɚɰɿɹ, ɩɿɫɥɹɨɩɟɪɚɰɿɣɧɢɣ ɛɿɥɶ, ɩɨɥɿɧɟɣɪɨɩɚɬɿɹ ɩɪɢ
ɤɪɢɬɢɱɧɢɯ ɫɬɚɧɚɯ ɬɚ ɯɪɨɧɿɱɧɢɣ ɩɨɲɢɪɟɧɢɣ ɛɿɥɶ (ɜɤɥɸɱɧɨ ɡ ɮɿɛɪɨɦɿɚɥɝɿɽɸ).
• ɇɟɬɪɚɜɦɚɬɢɱɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ ɦ'ɹɡɨɜɨ- ɫɤɟɥɟɬɧɨʀ ɫɢɫɬɟɦɢ: ɯɪɟɛɬɚ (ɯɪɨɧɿɱɧɢɣ ɬɚ ɝɨɫɬɪɢɣ ɩɨɩɟɪɟɤɨɜɢɣ ɛɿɥɶ, ɛɿɥɶ ɜ ɲɢʀ
ɬɚ ɝɪɭɞɧɨɦɭ ɜɿɞɞɿɥɿ), ɿɧɮɟɤɰɿɣɧɿ, ɮɭɧɤɰɿɨɧɚɥɶɧɿ, ɞɟɝɟɧɟɪɚɬɢɜɧɿ ɬɚ ɡɚɩɚɥɶɧɿ ɚɪɬɪɨɩɚɬɿʀ (ɧɚɩɪ. ɨɫɬɟɨɚɪɬɪɢɬ, ɪɟɜɦɚɬɨʀɞɧɢɣ
ɚɪɬɪɢɬ, ɚɧɤɿɥɨɡɭɸɱɢɣ ɫɩɨɧɞɢɥɿɬ, ɫɬɟɧɨɡ ɯɪɟɛɬɚ, ɪɨɡɥɚɞɢ ɫɤɪɨɧɟɜɨ-ɧɢɠɧɶɨɳɟɥɟɩɧɨɝɨ ɫɭɝɥɨɛɭ), ɦ'ɹɤɢɯ ɬɤɚɧɢɧ (ɧɚɩɪ.
ɬɟɧɞɢɬɿɧɿɬ, ɬɟɧɨɫɢɧɨɜɿɬ), ɮɿɛɪɨɛɥɚɫɬɿɱɧɿ ɪɨɡɥɚɞɢ (ɧɚɩɪ. ɯɜɨɪɨɛɚ Ⱦɸɩɭɿɬɪɟɧɚ, ɩɿɞɨɲɨɜɧɢɣ ɮɚɫɰɿʀɬ), ɭɪɚɠɟɧɧɹ ɩɥɟɱɨɜɨɝɨ
ɫɭɝɥɨɛɭ (ɧɚɩɪ. ɚɞɝɟɡɢɜɧɢɣ ɤɚɩɫɭɥɿɬ, ɫɢɧɞɪɨɦ ɪɨɬɚɬɨɪɧɨʀ ɦɚɧɠɟɬɢ), ɟɧɬɟɡɨɩɚɬɿʀ ɤɿɧɰɿɜɨɤ (ɧɚɩɪ. ɟɩɿɤɨɧɞɢɥɿɬ, ɬɟɧɞɢɧɿɬ,
ɿɥɿɨɬɿɛɿɚɥɶɧɢɣ ɫɢɧɞɪɨɦ, ɩ’ɹɬɤɨɜɚ ɲɩɨɪɚ, ɦɟɬɚɬɚɪɡɚɥɝɿɹ), ɿɧɲɿ ɩɨɪɭɲɟɧɧɹ ɦ’ɹɤɢɯ ɬɤɚɧɢɧ (ɧɚɩɪ. ɦɿɚɥɝɿɹ, ɮɿɛɪɨɦɿɚɥɝɿɹ),
ɪɨɡɥɚɞɢ ɫɬɪɭɤɬɭɪɢ ɬɚ ɳɿɥɶɧɨɫɬɿ ɤɿɫɬɤɨɜɨʀ ɬɤɚɧɢɧɢ (ɧɚɩɪ. ɨɫɬɟɨɩɨɪɨɡ, ɨɫɬɟɨɦɚɥɹɰɿɹ) ɬɚ ɿɧɲɿ ɤɿɫɬɤɨɜɿ ɪɨɡɥɚɞɢ (ɧɚɩɪ.
ɫɢɦɩɚɬɢɱɧɚ ɪɟɮɥɟɤɬɨɪɧɚ ɞɢɫɬɪɨɮɿɹ / ɤɨɦɩɥɟɤɫɧɢɣ ɪɟɝɿɨɧɚɥɶɧɢɣ ɛɨɥɶɨɜɢɣ ɫɢɧɞɪɨɦ), ɿɧɲɿ ɫɭɝɥɨɛɨɜɿ ɪɨɡɥɚɞɢ, ɭ ɬɨɦɭ ɱɢɫɥɿ
ɧɚɛɭɬɿ ɞɟɮɨɪɦɚɰɿʀ ɬɚ ɞɟɮɨɪɦɭɸɱɿ ɞɨɪɫɨɩɚɬɿʀ (ɧɚɩɪ. ɫɤɨɥɿɨɡ).
• ɉɫɢɯɿɱɧɿ ɬɚ ɩɨɜɟɞɿɧɤɨɜɿ ɪɨɡɥɚɞɢ, ɳɨ ɦɚɸɬɶ ɜɿɞɧɨɲɟɧɧɹ ɞɨ ɪɟɚɛɿɥɿɬɚɰɿʀ: ɧɚɩɪ. ɞɟɦɟɧɰɿʀ, ɛɿɩɨɥɹɪɧɢɣ ɚɮɟɤɬɢɜɧɢɣ ɪɨɡɥɚɞ,
ɩɿɫɥɹɬɪɚɜɦɚɬɢɱɧɢɣ ɫɬɪɟɫɨɜɢɣ ɪɨɡɥɚɞ, ɞɟɩɪɟɫɿɹ, ɬɪɢɜɨɠɧɢɣ ɪɨɡɥɚɞ, ɩɫɢɯɿɱɧɿ ɪɨɡɥɚɞɢ ɭ ɞɢɬɢɧɫɬɜɿ (ɧɚɩɪ. ɞɢɬɹɱɢɣ ɚɭɬɢɡɦ,
ɫɢɧɞɪɨɦ Ɋɟɬɬɚ, ɫɢɧɞɪɨɦ ɝɿɩɟɪɚɤɬɢɜɧɨɫɬɿ ɡ ɞɟɮɿɰɢɬɨɦ ɭɜɚɝɢ)
• ɋɟɪɰɟɜɨ-ɫɭɞɢɧɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ: ɧɚɩɪ. ɿɲɟɦɿɱɧɚ ɯɜɨɪɨɛɚ ɫɟɪɰɹ, ɝɨɫɬɪɢɣ ɿɧɮɚɪɤɬ ɦɿɨɤɚɪɞɚ, ɫɟɪɰɟɜɚ ɧɟɞɨɫɬɚɬɧɿɫɬɶ,
ɚɬɟɪɨɫɤɥɟɪɨɡ ɧɢɠɧɿɯ ɤɿɧɰɿɜɨɤ, ɦɿɨɤɚɪɞɢɬ, ɩɿɞɜɢɳɟɧɢɣ ɚɪɬɟɪɿɚɥɶɧɢɣ ɬɢɫɤ.
• Ɂɚɯɜɨɪɸɜɚɧɧɹ ɥɿɦɮɚɬɢɱɧɨʀ ɫɢɫɬɟɦɢ: ɧɚɩɪ. ɥɿɦɮɟɞɟɦɚ ɜɧɚɫɥɿɞɨɤ ɪɚɤɭ ɦɨɥɨɱɧɨʀ ɡɚɥɨɡɢ ɬɚ ɿɧɲɚ ɥɿɦɮɟɞɟɦɚ.
• Ɂɚɯɜɨɪɸɜɚɧɧɹ ɪɟɫɩɿɪɚɬɨɪɧɨʀ ɫɢɫɬɟɦɢ: ɚɫɬɦɚ, ɯɪɨɧɿɱɧɟ ɨɛɫɬɪɭɤɬɢɜɧɟ ɡɚɯɜɨɪɸɜɚɧɧɹ ɥɟɝɟɧɶ, ɥɟɝɟɧɟɜɚ ɝɿɩɟɪɬɟɧɡɿɹ,
ɬɪɚɧɫɩɥɚɧɬɚɰɿɹ ɥɟɝɟɧɶ.
• ȿɧɞɨɤɪɢɧɧɿ, ɯɚɪɱɨɜɿ ɬɚ ɦɟɬɚɛɨɥɿɱɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ: ɰɭɤɪɨɜɢɣ ɞɿɚɛɟɬ, ɭɫɤɥɚɞɧɟɧɧɹ ɦɟɬɚɛɨɥɿɱɧɨɝɨ ɫɢɧɞɪɨɦɭ, ɨɠɢɪɿɧɧɹ,
ɧɟɞɨʀɞɚɧɧɹ.
• Ƚɟɦɚɬɨɥɨɝɿɱɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ: ɮɭɧɤɰɿɨɧɚɥɶɧɿ ɧɚɫɥɿɞɤɢ ɥɟɣɤɟɦɿʀ, ɥɿɦɮɨɦɢ, ɬɪɚɧɫɩɥɚɧɬɚɰɿʀ ɤɿɫɬɤɨɜɨɝɨ ɦɨɡɤɭ.
• Ɂɚɯɜɨɪɸɜɚɧɧɹ ɲɥɭɧɤɨɜɨ-ɤɢɲɤɨɜɨɝɨ ɬɪɚɤɬɭ: ɧɚɩɪ. ɧɟɿɧɮɟɤɰɿɣɧɿ ɡɚɩɚɥɶɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ ɤɢɲɤɿɜɧɢɤɚ.
• Ɂɚɯɜɨɪɸɜɚɧɧɹ ɫɟɱɨɫɬɚɬɟɜɨʀ ɫɢɫɬɟɦɢ ɬɚ ɲɥɭɧɤɨɜɨ-ɤɢɲɤɨɜɨɝɨ ɬɪɚɤɬɭ: ɧɚɩɪ. ɫɮɿɧɤɬɟɪɧɿ ɪɨɡɥɚɞɢ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ, ɫɬɪɟɫɨɜɟ
ɧɟɬɪɢɦɚɧɧɹ ɫɟɱɿ ɚɛɨ ɤɚɥɭ, ɧɟɣɪɨɝɟɧɧɚ ɞɢɫɮɭɧɤɰɿɹ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ ɿ ɤɢɲɤɿɜɧɢɤɚ, ɫɢɧɞɪɨɦɢ ɯɪɨɧɿɱɧɨɝɨ ɬɚɡɨɜɨɝɨ ɛɨɥɸ, ɫɟɱɨ-
ɫɬɚɬɟɜɿ ɪɨɡɥɚɞɢ, ɯɪɨɧɿɱɧɚ ɧɢɪɤɨɜɚ ɧɟɞɨɫɬɚɬɧɿɫɬɶ.
• ɉɨɪɭɲɟɧɧɹ ɜɟɫɬɢɛɭɥɹɪɧɨʀ ɮɭɧɤɰɿʀ, ɳɨ ɦɚɸɬɶ ɜɿɞɧɨɲɟɧɧɹ ɞɨ ɪɟɚɛɿɥɿɬɚɰɿʀ: ɧɚɩɪ. ɝɨɥɨɜɨɤɪɭɠɿɧɧɹ, ɲɭɦ ɭ ɜɭɯɚɯ.
• Ɋɨɡɥɚɞɢ ɲɤɿɪɢ ɬɚ ɩɿɞɲɤɿɪɧɨʀ ɬɤɚɧɢɧɢ: ɧɚɩɪ. ɩɪɨɥɟɠɧɿ, ɩɫɨɪɿɚɡ.
• Ɏɭɧɤɰɿɨɧɚɥɶɧɿ ɧɚɫɥɿɞɤɢ ɪɚɤɭ: ɜɤɥɸɱɚɸɱɢ ɪɚɤ ɝɨɥɨɜɢ / ɲɢʀ, ɪɚɤ ɦɨɥɨɱɧɨʀ ɡɚɥɨɡɢ, ɪɚɤ ɬɿɥɚ ɦɚɬɤɢ, ɪɚɤ ɹɽɱɧɢɤɿɜ, ɪɚɤ
ɩɿɞɲɥɭɧɤɨɜɨʀ ɡɚɥɨɡɢ, ɪɚɤ ɩɟɪɟɞɦɿɯɭɪɨɜɨʀ ɡɚɥɨɡɢ, ɪɚɤ ɫɬɪɚɜɨɯɨɞɭ.
• ɇɚɫɥɿɞɤɢ ɩɟɜɧɢɯ ɿɧɮɟɤɰɿɣɧɢɯ ɬɚ ɩɚɪɚɡɢɬɚɪɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ: ɧɚɩɪ. ɧɚɫɥɿɞɤɢ ɩɪɨɤɚɡɢ, ɧɚɫɥɿɞɤɢ ɩɨɥɿɨɦɿɽɥɿɬɭ, ɥɿɦɮɚɬɢɱɧɢɣ
ɮɿɥɹɪɿɨɡ, ȼȱɅ-ɿɧɮɟɤɰɿɹ, ɛɪɭɰɟɥɶɨɡ.
• ɉɨɪɭɲɟɧɧɹ, ɩɨɜ'ɹɡɚɧɿ ɡ ɜɿɤɨɦ: ɧɚɩɪ. ɜɬɪɚɬɚ ɦ'ɹɡɿɜ ɬɚ ɚɬɪɨɮɿɹ-ɫɚɪɤɨɩɟɧɿɹ, ɫɟɧɿɥɶɧɚ ɚɫɬɟɧɿɹ ɬɚ ɫɥɚɛɤɿɫɬɶ.
• ȱɧɲɿ ɯɜɨɪɨɛɢ ɭ ɞɿɬɟɣ: ɧɚɩɪ. ɜɪɨɞɠɟɧɢɣ ɫɤɨɥɿɨɡ, ɸɜɟɧɿɥɶɧɢɣ ɨɫɬɟɨɯɨɧɞɪɨɡ ɯɪɟɛɬɚ, ɜɪɨɞɠɟɧɿ ɜɚɞɢ ɪɨɡɜɢɬɤɭ (ɧɚɩɪ. ɳɿɥɢɧɚ
ɝɭɛɢ, ɳɿɥɢɧɚ ɩɿɞɧɟɛɿɧɧɹ, ɜɪɨɞɠɟɧɿ ɚɧɨɦɚɥɿʀ ɫɟɪɰɹ), ɯɪɨɦɨɫɨɦɧɿ ɚɧɨɦɚɥɿʀ (ɧɚɩɪ. ɫɢɧɞɪɨɦ Ⱦɚɭɧɚ).
• Ʉɨɦɩɥɟɤɫɧɢɣ ɫɬɚɧ ɜɧɚɫɥɿɞɨɤ ɪɿɡɧɢɯ ɿ ɦɧɨɠɢɧɧɢɯ ɩɪɢɱɢɧ: ɫɢɧɞɪɨɦ ɩɨɫɬɿɥɶɧɨɝɨ ɪɟɠɢɦɭ, ɞɟɬɪɟɧɭɜɚɧɧɹ, ɦɭɥɶɬɢɫɢɫɬɟɦɧɚ
ɧɟɞɨɫɬɚɬɧɿɫɬɶ.

Ìåíåäæìåíò ÔÐÌ òàêîæ âêëþ÷ຠñêåðóâàííÿ
òà ïåðåì³ùåííÿ ì³æ çàêëàäàìè / ïîñëóãàìè. Âè-
êîðèñòàííÿ ÌÊÔ ìîæå ïîêðàùèòè ñòðóêòóðîâàíèé
ï³äõ³ä äî ïðîöåñó ðåàá³ë³òàö³¿ òà ïîëåãøèòè êîìó-
í³êàö³þ âñåðåäèí³ êîìàíäè ÔÐÌ ñòîñîâíî ïðî-
áëåì, ö³ëåé òà âòðó÷àíü6. Âñòàíîâëåííÿ ö³ëåé äî-
ïîìàãຠïàö³ºíòàì äîñÿãòè á³ëüøî¿ ÿêîñò³ æèòòÿ
àáî â³ä÷óòòÿ áëàãîïîëó÷÷ÿ òà á³ëüøî¿ ñàìîåôåê-
òèâíîñò³16. Îö³íêà çì³í ñòàíó ôóíêö³îíóâàííÿ òà
äîñÿãíåííÿ ö³ëåé º âàæëèâèìè âèì³ðàìè ðåçóëü-
òàò³â ó êë³í³÷í³é ïðàêòèö³ äëÿ äåìîíñòðàö³¿ åôåê-
òèâíîñò³ ïîñëóã17.
Ñïåêòð ñòàí³â çäîðîâ’ÿ, ÿê³ ë³êóþòü ë³êàð³
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
³äïîâ³äíî äî êîíöåïòóàëüíîãî îïèñó ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè3,4, áóäü-ÿêà õâîðîáà,
ïàòîëîã³ÿ àáî ñòàí çäîðîâ’ÿ, ùî ñïðè÷èíÿº ïîðó-
øåííÿ ôóíêö³é òà/àáî ñòðóêòóð îðãàí³çìó, îáìå-
æåííÿ àêòèâíîñò³ àáî îáìåæåííÿ ìîæëèâîñò³
ó÷àñò³, íàëåæèòü äî ñôåðè ä³ÿëüíîñò³ ÔÐÌ. Íàé-
âàæëèâ³ø³ ãðóïè ñòàí³â çäîðîâ’ÿ (çàõâîðþâàííÿ òà
ïîðóøåííÿ, âêëþ÷àþ÷è âðîäæåí³ àíîìà볿, ñòðåñ
òà â³êîâ³ ïðîáëåìè, à òàêîæ ïîøêîäæåííÿ òà òðàâ-

118 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 7 – ÑÔÅÐÀ Ê˲Ͳ×ÍÈÕ ÊÎÌÏÅÒÅÍÒÍÎÑÒÅÉ: ÔÐÌ ÍÀ ÏÐÀÊÒÈÖ²
ìè), ÿê³ ë³êóþòü ë³êàð³ ÔÐÌ, íàâåäåí³ â òàáëèö³ ²²
(ïîâíèé ïåðåë³ê ìîæå áóòè çíàéäåíèé ó äîäàòêó
2)1,2,18. Öåé ñïèñîê â³äíîñèòüñÿ äî íàéñó÷àñí³øî¿
âåðñ³¿ ̳æíàðîäíî¿ ñòàòèñòè÷íî¿ êëàñèô³êàö³¿ õâî-
ðîá òà ñïîð³äíåíèõ ïðîáëåì îõîðîíè çäîðîâ’ÿ
(ÌÊÕ) Âñåñâ³òíüî¿ îðãàí³çàö³¿ îõîðîíè çäîðîâ’ÿ
(ÂÎÎÇ) 19. Ïåðåë³ê áóâ ðîçøèðåíèé íà ï³äñòàâ³
ðåçóëüòàò³â ñåì³íàðó, ïðîâåäåíîãî International
Society of Physical and Rehabilitation Medicine
(ISPRM), ÿêèé âèçíà÷èâ ñòàíè çäîðîâ’ÿ, ùî ïîòðå-
áóþòü ðåàá³ë³òàö³¿20,21(Âñòàâêà 2).
Âñòàâêà 2: Ïðèêëàä ïàö³ºíòà ç³ ñòàíîì çäîðîâ’ÿ
òà ïîòðåáîþ â ë³êóâàíí³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè
25-ð³÷íèé ÷îëîâ³ê çàçíàâ äóæå âàæêî¿ ÷åðåïíî-ìîçêîâî¿
òðàâìè ï³ñëÿ äîðîæíüî-òðàíñïîðòíî¿ ïðèãîäè. Éîãî ïîðó-
øåííÿ âêëþ÷àëè ñïëóòàí³ñòü, äåçîð³ºíòàö³þ, çáóäæåííÿ ³ íå-
ìîæëèâ³ñòü êîâòàòè. Òîìó â³í ìàâ ñåðéîçíèé ðèçèê ðîçâèòêó
àñï³ðàö³éíî¿ ïíåâìîí³¿, ÿêà çàãðîæóâàëà æèòòþ òà ìîãëà ïî-
ðóøèòè ïîäàëüøå â³äíîâëåííÿ éîãî ìîçêîâèõ ôóíêö³é. Äî-
äàòêîâî, â íüîãî øâèäêî ðîçâèíóëèñü êîíòðàêòóðè íèæí³õ
ê³íö³âîê âíàñë³äîê çíåðóõîìëåííÿ òà íàäì³ðíî¿ àêòèâíîñò³
ì’ÿç³â (ñïàñòè÷í³ñòü).
³äïîâ³äíî, êîîðäèíîâàíà ðåàá³ë³òàö³ÿ çàáåçïå÷èëà éîìó
çíàõîäæåííÿ â òèõîìó ñåðåäîâèù³ òà äîïîìàãàëà êîìóí³êàö³¿
òà ðîçóì³ííþ éîãî ñèòóàö³¿. ˳êóâàííÿ áóëî ñïðÿìîâàíå íà
çíèæåííÿ òðèâîãè øëÿõîì ï³äõîäó äî êîíòðîëþ ïîâåä³íêè.
Äëÿ çàïîá³ãàííÿ àñï³ðàö³éíî¿ ïíåâìîí³¿ òà çàáåçïå÷åííÿ àäåê-
âàòíîãî õàð÷óâàííÿ éîìó áóâ âñòàíîâëåíèé çîíä äëÿ ãîäó-
âàííÿ ÷åðåç ïåðêóòàííó åíäîñêîï³÷íó ãàñòðîñòîìó (ÏÅÃ).
˳êóâàííÿ êîíòðàêòóð âêëþ÷àëî çíèæåííÿ ñïàñòè÷íîñò³,
ô³çè÷íî¿ òåðàﳿ òà åòàïíîãî îðòåçóâàííÿ. ϳñëÿ áàãàòüîõ
ì³ñÿö³â ³íòåíñèâíî¿ ðåàá³ë³òàö³¿ â³í çì³ã ïîâåðíóòèñÿ äîäîìó
ç ïîë³ïøåííÿì ïîâåä³íêè. Êîâòàííÿ â³äíîâèëîñÿ òàê, ùî â³í
ì³ã íîðìàëüíî õàð÷óâàòèñÿ, òà ÏÅà áóëî âèäàëåíî. ³í ïî÷àâ
õîäèòè, ³ ï³çí³øå çì³ã ïîâåðíóòèñÿ äî îïëà÷óâàíî¿ ðîáîòè.
Ó÷àñòü ë³êàð³â ÔÐÌ â öèõ óìîâàõ â îñíîâíîìó
ïîâ’ÿçàíà ç³ ñïðèÿííÿì ôóíêö³îíóâàííþ òà çìåíøåí-
íÿì íåñïðèÿòëèâèõ ôóíêö³îíàëüíèõ íàñë³äê³â, ùî
âèíèêàþòü â ãîñòð³é àáî ï³äãîñòð³é ôàçàõ, à òàêîæ
äëÿ ïàö³ºíò³â ç äîâãîòðèâàëèìè ñòàíàìè çäîðîâ’ÿ18.
˳êàð³ ÔÐÌ ìîæóòü òàêîæ çàáåçïå÷óâàòè âòðó-
÷àííÿ äëÿ ïåâíèõ ã³íåêîëîã³÷íèõ òà óðîëîã³÷íèõ
ñòàí³â1,2 àáî ïîðóøåíü øê³ðè òà ï³äøê³ðíî¿ òêàíè-
íè, ùî ìàþòü â³äíîøåííÿ äî ÔÐÌ (íàïð. ïðîëåæ-
íåâ³ âèðàçêè, âòîðèíí³ ïîøêîäæåííÿ øê³ðè âíàñë³-
äîê êîíòðàêòóð).
²ñíóº ö³ëèé ðÿä çàãàëüíèõ ïðîáëåì ïðè áàãàòü-
îõ ñòàíàõ çäîðîâ’ÿ, ç ÿêèìè ë³êàð³ ÔÐÌ ñòèêàþòü-
ñÿ ùîäíÿ1,2. Âîíè ìîæóòü âêëþ÷àòè:
– òðèâàëèé ïîñò³ëüíèé ðåæèì òà ³ììîá³ë³çàö³ÿ, ùî
ïðèçâîäèòü äî äåêîíäèö³þâàííÿ ïàö³ºíò³â ³, ÿê
íàñë³äîê, ñïðè÷èíÿº âòðàòó ô³çè÷íîãî òà ïñèõî-
ëîã³÷íîãî ôóíêö³îíóâàííÿ;
– ðóõîâ³ äåô³öèòè, ÿê³ âèêëèêàþòü ñëàáê³ñòü òà/
àáî ñåíñîðíèé äåô³öèò ç âòðàòîþ îñîáèñòîãî
ôóíêö³îíóâàííÿ;
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
– ñïàñòè÷í³ñòü, ùî ïðèçâîäèòü äî äåôîðìàö³¿
ê³íö³âîê òà ïðîáëåì çîâí³øíüîãî âèãëÿäó;
– áîëüîâ³ ñèíäðîìè;
– òðóäíîù³ êîìóí³êàö³¿;
– çì³íè íàñòðîþ, ïîâåä³íêè òà îñîáèñòîñò³;
– äèñôóíêö³¿ ñå÷îâîãî ì³õóðà ³ êèøê³âíèêà, ÿê³
çàçâè÷àé çóñòð³÷àþòüñÿ ó ïàö³ºíò³â ç îáìåæåí-
íÿìè æèòòºä³ÿëüíîñò³;
– ïðîëåæí³, ÿê ðèçèê ïðè çíåðóõîìëåíîñò³ ó âèïàä-
êàõ ñïèííî-ìîçêîâèõ òðàâì, ä³àáåòó, ïîã³ðøåíí³
ô³çè÷íîãî ñòàíó ³ ïîõèëîìó â³ö³;
– äèñôàã³þ – ñòàí ïîðóøåííÿ êîâòàííÿ, ïðè ÿêî-
ìó ëþäè âòðà÷àþòü íàñîëîäó â³ä ¿æ³, à òàêîæ º
ðèçèê àñï³ðàö³éíî¿ ïíåâìîí³¿ òà íåäî¿äàííÿ;
– ñåêñóàëüíó äèñôóíêö³þ, ùî îõîïëþº ïðîáëåìè
³äåíòè÷íîñò³ òà ñàìîðåàë³çàö³¿, à òàêîæ ôóíêö³î-
íóâàííÿ îðãàí³â;
– çì³íè â ñ³ìåéí³é äèíàì³ö³, îñîáèñòèõ ñòîñóíêàõ,
ìîæëèâîñòÿõ êàð’ºðè òà ô³íàíñîâ³é áåçïåö³.
ßê ïîâ³äîìëÿëîñÿ â «Âñåñâ³òí³é äîïîâ³ä³ ç îá-
ìåæåíü æèòòºä³ÿëüíîñò³»22, î÷³êóºòüñÿ, ùî îáìå-
æåííÿ æèòòºä³ÿëüíîñò³ áóäóòü çðîñòàòè â óñüîìó
ñâ³òîâ³ òà çàëèøàòèìóòüñÿ âèêëèêîì äëÿ ë³êàð³â
ÔÐÌ, ùîäî çäàòíîñò³ âòðó÷àííÿ äî ð³çíèõ ñòàí³â
çäîðîâ’ÿ, ùî ïîòðåáóþòü ðåàá³ë³òàö³¿. Öå çðîñòàí-
íÿ äຠìîæëèâ³ñòü ñïðèÿííÿ ë³êàðñüê³é ñïåö³àëü-
íîñò³ ÔÐÌ òà ï³äêðåñëåííÿ ¿¿ âàæëèâîñò³.
Âàæëèâ³ñòü ÔÐÌ ó ë³êóâàíí³ ð³çíèõ çàõâîðþ-
âàíü ³íîä³ çíåâàæàºòüñÿ ç îãëÿäó íà çàâäàííÿ ÔÐÌ
ó ðåàá³ë³òàö³¿. Ïðîòå ÔÐÌ ó á³ëüøîñò³ êðà¿í º ñïå-
ö³àëüí³ñòþ, ÿêà ë³êóº ãîñòð³ òà õðîí³÷í³ ì’ÿçîâî-
ñêåëåòí³ ñòàíè (íàïð. ïîïåðåêîâèé á³ëü, á³ëü ó øè¿
òà ïëå÷³, á³ëü ó òàçîâ³é òà êîë³íí³é ä³ëÿíêàõ òà áà-
ãàòî ³íøèõ), ïîðóøåííÿ íåðâîâî¿ ñèñòåìè (íàïð.
ñïàñòè÷í³ñòü, ïîðóøåííÿ áàëàíñó, àòàêñ³ÿ),
õðîí³÷í³ øèðîêî ðîçïîâñþäæåí³ áîëüîâ³ ñèíäðîìè,
à òàêîæ ñåðöåâî-ñóäèíí³, ìåòàáîë³÷í³ òà ðåñï³ðà-
òîðí³ äèñôóíêö³¿, ë³ìôàòè÷í³ çàõâîðþâàííÿ, äèñ-
ôóíêö³¿ ñå÷îâîãî ì³õóðà òà êèøê³âíèêà. Äîäàòêî-
âî, ÔÐÌ ìຠñïåöèô³÷íó êîìïåòåíòí³ñòü ó ë³êóâàíí³
ñïåöèô³÷íèõ ñèíäðîì³â, òàêèõ, ÿê ñèíäðîì âèãîðàí-
íÿ, ðîçëàäè ñíó, ñëàáê³ñòü, à òàêîæ äèñôóíêö³ÿ
îðãàí³â ÷åðåâíî¿ òà òàçîâî¿ ïîðîæíèíè (ñèíäðîì
õðîí³÷íîãî òàçîâîãî áîëþ, ñèíäðîì ïîäðàçíåíîãî
êèøê³âíèêà òà ³íø³)23.
ijàãíîñòèêà õâîðîá ó ô³çè÷í³é
òà ðåàá³ë³òàö³éíèé ìåäèöèí³
(ìåäè÷íèé ä³àãíîç)
ijàãíîç â ô³çè÷í³é òà ðåàá³ë³òàö³éíèé ìåäèöèí³
âêëþ÷ຠìåäè÷íèé ä³àãíîç òà ôóíêö³îíàëüíå îö³-
íþâàííÿ. Ñòàí çäîðîâ’ÿ º óçàãàëüíþþ÷èì òåðì³-
íîì äëÿ õâîðîá, ðîçëàä³â, ïîøêîäæåíü àáî òðàâì,
à òàêîæ ³íøèõ îáñòàâèí, òàêèõ ÿê âàã³òí³ñòü, ñòà-
119
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ð³ííÿ, âðîäæåíà àíîìàë³ÿ àáî ãåíåòè÷íà
ñõèëüí³ñòü12. Îñê³ëüêè øèðîêèé ñïåêòð ìåäè÷íèõ
ñòàí³â ïîêðèâàºòüñÿ ô³çè÷íîþ òà ðåàá³ë³òàö³éíîþ
ìåäèöèíîþ, ë³êàð ÔÐÌ âèçíຠíåîáõ³äí³ñòü ïîñòà-
íîâêè îäíîãî (àáî ê³ëüêîõ) âèçíà÷åíèõ ìåäè÷íèõ
ä³àãíîç³â ïåðåä ïî÷àòêîì ë³êóâàííÿ ³ ïðîâåäåííÿ
ïðîáëåìíî-îð³ºíòîâàíèõ âòðó÷àíü ô³çè÷íî¿ òà ðåà-
á³ë³òàö³éíî¿ ìåäèöèíè.
Äëÿ ìåäè÷íîãî ä³àãíîçó ë³êàð ÔÐÌ çîñåðåä-
æóºòüñÿ íà àíàìíåç³ ïàö³ºíòà òà êë³í³÷íîìó îáñòå-
æåíí³, à òàêîæ íà êë³í³÷íèõ ä³àãíîñòè÷íèõ ïðîöå-
äóðàõ, òàêèõ, ÿê ëàáîðàòîðí³ äîñë³äæåííÿ, ìåòîäè
â³çóàë³çàö³¿, åëåêòðîô³ç³îëîã³÷í³ òåñòè òîùî. ̳æíà-
ðîäíà ñòàòèñòè÷íà êëàñèô³êàö³ÿ õâîðîá òà ñïîð³-
äíåíèõ ïðîáëåì îõîðîíè çäîðîâ’ÿ (ÌÊÕ-Õ) – öå
êëàñèô³êàö³éíà ñèñòåìà, ùî âèêîðèñòîâóºòüñÿ çà-
ðàç äëÿ êîäóâàííÿ ä³àãíîçó ñòàí³â çäîðîâ’ÿ19.
˳êàð³ ÔÐÌ äåòàëüíî âèâ÷àþòü àíàìíåç ÷èí-
íîãî ñòàíó çäîðîâ’ÿ, àíàìíåç ìåäè÷íèõ ñòàí³â â
ìèíóëîìó, ïðîâîäÿòü îãëÿä ñèñòåì îðãàí³çìó ðà-
çîì ³ç ôóíêö³îíàëüíèì ñòàòóñîì (ìîá³ëüí³ñòü, ñà-
ìîîáñëóãîâóâàííÿ, ï³çíàííÿ, ñï³ëêóâàííÿ, ïðîôå-
ñ³éíà òà ðåêðåàö³éíà àêòèâíîñò³), à òàêîæ ñ³ìåéíèé
òà ñîö³àëüíèé àíàìíåç24. Ïåðøîðÿäíå çíà÷åííÿ
ìຠðåòåëüíå ìåäè÷íå îáñòåæåííÿ, âêëþ÷àþ÷è
çàãàëüíèé ìåäè÷íèé, íåâðîëîã³÷íèé îãëÿäè, à òà-
êîæ îãëÿä ì’ÿçîâî-ñêåëåòíî¿ ñèñòåìè. Ñïåö³àëüí³
òåñòè àáî ïðîâîêàö³éí³ ìàíåâðè, òàê³ ÿê òåñòè äëÿ
âèÿâëåííÿ ³ìï³äæìåíò- ñèíäðîìó ïëå÷îâîãî ñóã-
ëîáó, òåñò Finkelstein, òåñò McMurray àáî ³íø³,
ìîæóòü áóòè íåîáõ³äíèìè äëÿ ä³àãíîñòèêè äåÿêèõ
ì’ÿçîâî-ñêåëåòíèõ ñòàí³â24.
Äëÿ ä³àãíîñòèêè áàãàòüîõ ñòàí³â çäîðîâ’ÿ âå-
ëè÷åçíå çíà÷åííÿ ìàþòü ìåòîäè â³çóàë³çàö³¿. Îä-
íèì ç çàãàëüíèõ ìåòîä³â º ðåíòãåíîëîã³÷íå äîñë³ä-
æåííÿ. Âîíî äîçâîëÿº ï³äòâåðäæóâàòè ä³àãíîç ³
çä³éñíþâàòè ìîí³òîðèíã ñòàö³îíàðíèõ ïàö³ºíò³â.
Ïåðø çà âñå, ðåíòãåíîëîã³÷íå îáñòåæåííÿ äàº
³íôîðìàö³þ ïðî óðàæåííÿ ê³ñòîê, à òàêîæ ïðî êàëü-
öèô³êàö³þ â ïóõëèíàõ, ì’ÿêèõ òêàíèíàõ, êðîâîíîñ-
íèõ ñóäèíàõ òîùî. Çàâäÿêè ñâî¿ì ÷èñëåííèì
ïåðåâàãàì óëüòðàçâóêîâå äîñë³äæåííÿ îïîðíî-ðó-
õîâîãî àïàðàòó â³ä³ãðຠâàæëèâó ðîëü â ä³àãíîñòèö³,
à òàêîæ ïðè ìîí³òîðèíãó ð³çíèõ ì’ÿçîâî-ñêåëåòíèõ
ïîðóøåíü. Íà â³äì³íó â³ä ðåíòãåíîëîã³÷íîãî äîñ-
ë³äæåííÿ òà ðåíòãåí³âñüêî¿ êîìï’þòåðíî¿ òîìî-
ãðàô³¿, âîíî íå ïîòðåáóº ðàä³àö³éíîãî îïðîì³íåííÿ,
º íå³íâàçèâíèì ³, íàñàìïåðåä, äëÿ íüîãî íåìຠâ³äî-
ìèõ ïðîòèïîêàçàíü. Êð³ì òîãî, ³ñíóº ìîæëèâ³ñòü
ïîâòîðíîãî óëüòðàçâóêîâîãî îáñòåæåííÿ, ³ âîíî
äóæå ÷óòëèâå äî çì³í. Öå äîçâîëÿº ïîòåíö³éíî
âèêîðèñòîâóâàòè óëüòðàçâóêîâå îáñòåæåííÿ äëÿ
ìîí³òîðèíãó ïðîãðåñóâàííÿ çàõâîðþâàííÿ ³ îö³íêè
òåðàïåâòè÷íî¿ åôåêòèâíîñò³ ì³ñöåâîãî òà ñèñòåì-
íîãî ë³êóâàííÿ. Äîäàòêîâî äî ñòàíäàðòíèõ óëüò-
120 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ðàçâóêîâèõ äîñë³äæåíü, çàðàç çá³ëüøóºòüñÿ âèêî-
ðèñòàííÿ êîëüîðîâîãî äîïïëåð³âñüêîãî òà åíåðãå-
òè÷íîãî äîïëåð³âñüêîãî óëüòðàçâóêîâîãî äîñë³ä-
æåííÿ â ä³àãíîñòèö³ ñèíîâ³òó, òåíîñèíîâ³òó,
åíòåçèòó òà áóðñèòó. Åíåðãåòè÷íå äîïïëåð³âñüêå
äîñë³äæåííÿ, ÿêå äóæå ÷óòëèâå ó äåìîíñòðàö³¿
çàïàëåííÿ, çàçâè÷àé âèêîðèñòîâóºòüñÿ ïðè ðåâìà-
òîëîã³÷íèõ çàõâîðþâàííÿõ, äëÿ ä³àãíîñòèêè òà
ìîí³òîðèíãó ñèíîâ³òó, òðàâìàòè÷íèõ óøêîäæåíü,
íàïð. ï³ä ÷àñ ë³êóâàííÿ òåíäèí³òó àáî ïðè îö³íö³
îá’ºìíèõ óðàæåíü (ïîð³âíÿííÿ äîáðîÿê³ñíèõ òà
çëîÿê³ñíèõ çì³í)25.
Ðåíòãåí³âñüêà êîìï’þòåðíà òîìîãðàô³ÿ (ÊÒ) º
âèñîêî÷óòëèâèì ñó÷àñíèì ìåòîäîì ä³àãíîñòèêè.
Â³í º áåçáîë³ñíèì òà çàäîâ³ëüíî¿ òî÷íîñò³, àëå
ï³äâåðãຠïàö³ºíòà âïëèâó ðåíòãåí³âñüêîãî âèïðî-
ì³íþâàííÿ. ÊÒ ë³ïøå, í³æ ÌÐÒ, â ä³àãíîñòèö³ êðî-
âîòå÷³, êàëüöèô³êàö³¿ òà çì³í â ê³ñòêàõ ÷åðåïà.
Ìàãí³òíî-ðåçîíàíñíà òîìîãðàô³ÿ (ÌÐÒ) ðàçîì ç
ðåíòãåí³âñüêîþ êîìï’þòåðíîþ òîìîãðàô³ºþ º
îäí³ºþ ç íàéâàæëèâ³øèõ ìåäè÷íèõ ³ííîâàö³é, ùî
ïîë³ïøóº íàäàííÿ äîïîìîãè ïàö³ºíòàì 27. ßêùî
êë³í³÷íå îáñòåæåííÿ âêàçóº íà íåðâîâî-ì’ÿçîâó
õâîðîáó àáî äèñôóíêö³þ ñå÷îâîãî ì³õóðà, ïîâíà
îö³íêà öèõ ïàö³ºíò³â âêëþ÷ຠâ³äïîâ³äíî åëåêòðî-
ä³àãíîñòè÷íå àáî óðîäèíàì³÷íå îáñòåæåííÿ. Çàä-
ëÿ ïðàâèëüíîãî ïðîâåäåííÿ äèôåðåíö³éíî¿ ä³àãíî-
ñòèêè, îáñòåæåííÿ ïîâèííå ïðîâîäèòèñÿ òåõí³÷íî
ãðàìîòíî ³ ðåçóëüòàòè ïîâèíí³ áóòè ïðàâèëüíî
³íòåðïðåòîâàíèìè. Ðåçóëüòàòè öüîãî îáñòåæåííÿ
ïîâèíí³ óìîæëèâèòè âèÿâëåííÿ îñíîâíèõ ïàòîëî-
ã³÷íèõ ïðîöåñ³â, òàêèõ, ÿê ó âèïàäêó íåðâîâî-ì’ÿ-
çîâîãî çàõâîðþâàííÿ: ñåíñîðíà, ìîòîðíà àáî ñåí-
ñîìîòîðíà ïîë³íåâðîïàò³ÿ, ìîíîíåâðîïàò³ÿ,
ìíîæèííà ìîíîíåâðîïàò³ÿ, ïîë³ðàäèêóëîíåâðîïà-
ò³ÿ, ðàäèêóëîïàò³ÿ, ì³îïàò³ÿ, ïîðóøåííÿ íà ð³âí³
íåðâîâî-ì’ÿçîâîãî ç’ºäíàííÿ; ó âèïàäêó äèñôóíêö³¿
ñå÷îâîãî ì³õóðà: íàäëèøêîâà àáî íåäîñòàòíÿ àê-
òèâí³ñòü äåòðóçîðó àáî ñïàçìîâàíèé äåòðóçîð,
íåäîñòàòí³ñòü ñô³íêòåðà, äåòðóçîðíî-ñô³íêòåðíà
äèññèíåðã³ÿ, ÷óòëèâà äèñôóíêö³ÿ. Ó ïåâíèõ âèïàä-
êàõ ô³çèêàëüíå îáñòåæåííÿ, óðîäèíàì³÷í³ òà åëåê-
òðîä³àãíîñòè÷í³ äàí³ ìîæóòü áóòè âèêîðèñòàíèìè
äëÿ îö³íêè ïðîãíîçó â³äíîâëåííÿ àáî äëÿ îö³íêè
ïðîãðåñóâàííÿ çàõâîðþâàííÿ àáî âèáîðó ï³äõîäó
ùîäî âåäåííÿ ïàö³ºíòà28. ßêùî êë³í³÷íå îáñòåæåí-
íÿ âêàçóº íà äèñôóíêö³þ ñå÷îâîãî ì³õóðà, ïîâíå
îáñòåæåííÿ öèõ ïàö³ºíò³â âêëþ÷àº, â äåÿêèõ âèïàä-
êàõ, çàçâè÷àé, ïðè íåéðîãåííèõ ðîçëàäàõ, óðîäèíà-
ì³÷íå, ³ â á³ëüø ð³äêèõ âèïàäêàõ åëåêòðîä³àã-
íîñòè÷íå îáñòåæåííÿ, îð³ºíòîâàíå íà ãðóäí³,
ïîïåðåêîâ³ ³ êðèæîâ³ íåéðîòîìè òà ñïèíàëüí³ íåðâè.
Çàäëÿ ïðàâèëüíîãî ïðîâåäåííÿ äèôåðåíö³éíî¿ ä³àã-
íîñòèêè, îáñòåæåííÿ ïîâèííå ïðîâîäèòèñÿ òåõí³-
÷íî ãðàìîòíî ³ ðåçóëüòàòè ïîâèíí³ áóòè ïðàâèëü-
¹2(2) *2018
 ÐÎÇÄ²Ë 7 – ÑÔÅÐÀ Ê˲Ͳ×ÍÈÕ ÊÎÌÏÅÒÅÍÒÍÎÑÒÅÉ: ÔÐÌ ÍÀ ÏÐÀÊÒÈÖ²
íî ³íòåðïðåòîâàíèìè. Ðåçóëüòàòè öüîãî îáñòåæåí-
íÿ ïîâèíí³ óìîæëèâèòè âèÿâëåííÿ îñíîâíèõ ïàòî-
ëîã³÷íèõ ïðîöåñ³â, òàêèõ, ÿê: ã³ïåðàêòèâí³ñòü äåò-
ðóçîðà ï³ä ÷àñ ôàçè íàïîâíåííÿ ñå÷îâîãî ì³õóðà,
íåäîñòàòí³ñòü ñô³íêòåðà ï³ä ÷àñ ôàçè íàïîâíåííÿ
ñå÷îâîãî ì³õóðà, ã³ïîàêòèâí³ñòü äåòðóçîðà àáî
àêîíòðàêòèëüíèé äåòðóçîð ï³ä ÷àñ ôàçè âèïîðîæ-
íåííÿ ñå÷îâîãî ì³õóðà, äåòðóçîðíî-ñô³íêòåðíà
äèññèíåðã³ÿ ï³ä ÷àñ ôàçè âèïîðîæíåííÿ ñå÷îâîãî
ì³õóðà, ñåíñîðíà äèñôóíêö³ÿ ï³ä ÷àñ ôàçè íàïîâ-
íåííÿ òà âèïîðîæíåííÿ ñå÷îâîãî ì³õóðà. Ó äåÿêèõ
âèïàäêàõ ô³çèêàëüíå, óðîäèíàì³÷íå òà åëåêòðîä³-
àãíîñòè÷íå îáñòåæåííÿ ìîæóòü âèêîðèñòîâóâàòè-
ñÿ äëÿ îö³íêè ïðîãíîçó â³äíîâëåííÿ, àáî äëÿ îö³í-
êè ïðîãðåñóâàííÿ çàõâîðþâàííÿ, àáî îö³íêè ñàìîãî
ï³äõîäó äî ìåíåäæìåíòó.
Äëÿ ï³äâèùåííÿ åôåêòèâíîñò³ ä³àãíîñòèêè òà
âèçíà÷åííÿ ñòàíó ïàö³ºíòà ³ éîãî/¿¿ ô³çè÷íèõ çäàò-
íîñòåé ë³êàð ÔÐÌ ìîæå âèêîðèñòîâóâàòè âàë³äî-
âàíèé íàá³ð òåõíîëîã³é, ÿê³ ç âåëèêîþ òî÷í³ñòþ
³íôîðìóþòü ïðî îñíîâí³ îñîáëèâîñò³, òàê³, ÿê ì’ÿ-
çîâà ñèëà (ñèëà, ðîáîòà) á³ëüøîñò³ ì’ÿçîâèõ ãðóï,
òðüîõïëîùèííèé ä³àïàçîí ðóõó ñåãìåíò³â ò³ëà,
ñïîñ³á õîäüáè (ê³íåòè÷íèé ³ ê³íåìàòè÷íèé àíàë³ç),
çäàòí³ñòü äî óòðèìàííÿ ð³âíîâàãè â ð³çíèõ ïîëî-
æåííÿõ ³ ì’ÿçîâà åëåêòðè÷íà àêòèâí³ñòü, ÿêà âè-
ì³ðþºòüñÿ ïîâåðõíåâèìè àáî ãîëêîâèìè åëåêòðî-
äàìè ï³ä ÷àñ ðóõó àáî ó ñïîêî¿. Âñ³ ö³ äîñë³äæåííÿ
âèÿâèëèñÿ â³äì³ííèìè ³íñòðóìåíòàìè äëÿ âèçíà-
÷åííÿ ñòàòóñó òà ìîí³òîðèíãó òåðàïåâòè÷íîãî ïðî-
öåñó. Áåðó÷è äî óâàãè õàðàêòåðèñòèêè íàéá³ëüø
÷àñòî âèêîðèñòîâóâàíèõ ìåòîä³â ä³àãíîñòèêè ïðè
òðàâìàõ òà çàõâîðþâàííÿõ îïîðíî-ðóõîâîãî àïà-
ðàòó, ë³êàð ÔÐÌ íåñå çíà÷íó â³äïîâ³äàëüí³ñòü ïðè
¿õ âèáîð³. Âîíà / â³í ìຠçàâäàííÿ ä³àãíîñòóâàòè
ïðîáëåìó ÿêîìîãà òî÷í³øå, àëå îäíî÷àñíî íå çàâ-
äàâàòè øêîäè ïàö³ºíòîâ³. Äîäàòêîâî, ï³ñëÿ çàâåð-
øåííÿ ðåàá³ë³òàö³éíî¿ ïðîãðàìè òà âè÷åðïàííÿ âñ³õ
ïîäàëüøèõ ìîæëèâîñòåé ë³êóâàííÿ, ñïåö³àë³ñò ç
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè ïîâèíåí ïðî-
âåñòè îñòàòî÷íó îö³íêó ôóíêö³îíàëüíîñò³ ïàö³ºíòà.
Íà ï³äñòàâ³ ö³º¿ ³íôîðìàö³¿ ïðîâîäèòüñÿ îö³íêà íå-
çàëåæíîñò³ ïàö³ºíòà â àêòèâíîñòÿõ ïîâñÿêäåííîãî
æèòòÿ, íàïð. ïîòðåáà â ñòîðîíí³é äîïîìîç³ ³ îö³í-
êà ïðàöåçäàòíîñò³, íàïð. íåîáõ³äí³ñòü çì³íè ðîáîòè
àáî âèõîä³ íà ïåíñ³þ âíàñë³äîê îáìåæåíü æèòòº-
ä³ÿëüíîñò³. Öå ìຠâåëèêå çíà÷åííÿ äëÿ çäîðîâ’ÿ,
àëå òàêîæ ³ ñîö³àëüíî-åêîíîì³÷íó âàæëèâ³ñòü. Âå-
ëèêèé ñïåêòð ëàáîðàòîðíèõ äîñë³äæåíü òàêîæ
ìîæå âèêîðèñòîâóâàòèñÿ ë³êàðÿìè ÔÐÌ.
Îêð³ì êë³í³÷íîãî îáñòåæåííÿ, â³çóàë³çàö³ÿ òà
ëàáîðàòîðíå îáñòåæåííÿ, âèì³ðþâàííÿ ôóíêö³î-
íàëüíèõ îáìåæåíü òà ôóíêö³îíàëüíîãî ïîòåíö³àëó,
ÿêèé ñòîñóºòüñÿ ïðîãðàìè ÔÐÌ, º îñíîâíîþ ÷àñ-
òèíîþ ä³àãíîñòèêè â ô³çè÷í³é òà ðåàá³ë³òàö³éí³é
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ìåäèöèí³. Ö³ âèì³ðþâàííÿ ìîæóòü âêëþ÷àòè
àíàë³ç ôóíêö³é ì’ÿç³â (ñèëà, åëåêòðè÷íà àêòèâí³ñòü
òîùî), ãîí³îìåòð³þ äëÿ ä³àïàçîíó ðóõó ñóãëîá³â,
òåñòóâàííÿ öèðêóëÿòîðíèõ ôóíêö³é (àðòåð³àëüíèé
òèñê, ÷àñòîòà ñåðöåâèõ ñêîðî÷åíü, ñòðåñ-íàâàíòà-
æåííÿ), ëåãåíåâî¿ ôóíêö³¿, áàëàíñó ³ õîäè, ðóêî-
ñòèñêàííÿ òà ³íøèõ18.
Áàãàòîì³ðíå îö³íþâàííÿ ôóíêö³îíóâàííÿ
(ôóíêö³îíàëüíå îö³íþâàííÿ)
Äîäàòêîâî äî ìåäè÷íîãî ä³àãíîçó, ôóíêö³î-
íàëüíå îö³íþâàííÿ º íåîáõ³äíîþ âèìîãîþ äëÿ ë³êà-
ðÿ ÔÐÌ, îñê³ëüêè öå º ñêëàäîâîþ ìåäè÷íî¿ ñïåö³-
àëüíîñò³, ÿêà ãîëîâíèì ÷èíîì çîñåðåäæåíà íà
ïîë³ïøåíí³ ôóíêö³îíóâàííÿ4. ijàãíîñòè÷íèé ïðîöåñ
â ðåàá³ë³òàö³¿ òðàäèö³éíî íàçèâàþòü «îö³íþâàí-
íÿì»26, îòæå «îö³íþâàííÿ ôóíêö³îíóâàííÿ» – öå
íàéêðàùèé òåðì³í äëÿ ôóíêö³îíàëüíîãî îö³íþâàí-
íÿ4. Òàáëèöÿ ²²² íàäຠîãëÿä òåñò³â òà ³íñòðóìåíò³â
îö³íþâàííÿ, ÿê³ ÷àñòî âèêîðèñòîâóþòüñÿ â ô³çè÷í³é
òà ðåàá³ë³òàö³éí³é ìåäèöèí³.
Ôóíêö³îíóâàííÿ – öå æèòòºâèé äîñâ³ä ëþäñüêî¿
³ñòîòè, â ÿêîìó ïåðåïëåòåí³ îðãàí³çì, ïåðñîíà òà
ñóñï³ëüñòâî12. ³äïîâ³äíî äî êîíöåïòóàëüíî¿ ìî-
äåë³ ÂÎÎÇ – ̳æíàðîäíî¿ êëàñèô³êàö³¿ ôóíêö³îíó-
âàííÿ, îáìåæåíü æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ
(ÌÊÔ), ôóíêö³îíóâàííÿ º çàãàëüíèì òåðì³íîì, ùî
âêëþ÷ຠôóíêö³¿ òà ñòðóêòóðè îðãàí³çìó, àê-
òèâí³ñòü òà ó÷àñòü5. Îö³íþâàííÿ ôóíêö³îíóâàííÿ
ïîâèííî çä³éñíþâàòèñÿ íà îñíîâ³ êîíöåïòóàëüíî¿
îñíîâè, íàäàíî¿ ÌÊÔ, òà ïîâèííî âêëþ÷àòè ôóíêö³¿
òà ñòðóêòóðè îðãàí³çìó, à òàêîæ àêòèâí³ñòü òà
ó÷àñòü3 (Âñòàâêà 3). Äëÿ òîãî, ùîá ïîâí³ñòþ â³ä-
îáðàçèòè ôóíêö³îíóâàííÿ êîíêðåòíî¿ îñîáè, ³ñíóº
ïîòðåáà â îö³íþâàíí³ äàíèõ ïðî îáñÿãè ôóíêö³îíó-
âàííÿ, âêëþ÷àþ÷è ïîðóøåííÿ ôóíêö³é òà ñòðóêòóð
îðãàí³çìó, îáìåæåíü àêòèâíîñò³ òà ó÷àñò³, áàð’ºð³â
ñåðåäîâèùà òà ñïðèÿòëèâèõ ÷èííèê³â, à òàêîæ
ñïðèéíÿòòÿ ³ î÷³êóâàííÿ ³íäèâ³äóóì³â26.
Ôóíêö³¿ òà ñòðóêòóðè îðãàí³çìó ñèñòåìàòè÷íî
êëàñèô³êîâàí³ ó âîñüìè â³äïîâ³äíèõ ðîçä³ëàõ
ÌÊÔ5. Ôóíêö³ÿìè îðãàí³çìó, ùî âèìàãàþòü îö³íþ-
âàííÿ ïðè á³ëüøîñò³ ì’ÿçîâî-ñêåëåòíèõ ñòàí³â º
á³ëü, ðóõëèâ³ñòü ñóãëîá³â, ñòàá³ëüí³ñòü ñóãëîá³â,
ì’ÿçîâà ñèëà, ì’ÿçîâèé òîíóñ, âèòðèâàë³ñòü ì’ÿç³â,
åíåðã³ÿ, ñîí, åìîö³éí³ ôóíêö³¿, òîëåðàíòí³ñòü äî
ô³çè÷íèõ âïðàâ, ïàòåðíè õîäüáè ³ ñåêñóàëüí³
ôóíêö³¿. Îö³íþâàííÿ ôóíêö³é îðãàí³çìó ïðè íåâðî-
ëîã³÷íèõ ñòàíàõ ìຠòàêîæ âêëþ÷àòè ï³çíàâàëüí³
ôóíêö³¿ (ñâ³äîì³ñòü, îð³ºíòàö³ÿ, óâàãà, ïàì’ÿòü,
ìîâà, ñïðèéíÿòòÿ), äîòèê òà ³íø³ ÷óòëèâ³ ôóíêö³¿,
ôóíêö³¿ ãîëîñó òà ìîâëåííÿ, êîíòðîëü äîâ³ëüíîãî
ðóõó, äåôåêàö³ÿ òà ñå÷îâèïóñêàííÿ. Äåôîðìàö³¿
ñóãëîá³â, àòðîô³ÿ ì’ÿç³â, ñòðóêòóðí³ ïîðóøåííÿ
121
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Òàáëèöÿ ²²². – ijàãíîñòè÷í³ ³íñòðóìåíòè òà çàñîáè îö³íþâàííÿ â ô³çè÷í³é òà ðåàá³ë³òàö³éí³é ìåäèöèíè: àêòèâí³ñòü, ó÷àñòü
òà êîíòåêñòóàëüí³ ôàêòîðè
Ɂɚɫɨɛɢ ɫɩɟɰɿɚɥɶɧɨɝɨ ɤɥɿɧɿɱɧɨɝɨ ɬɚ ɬɟɯɧɿɱɧɨɝɨ ɨɰɿɧɸɜɚɧɧɹ ɚɤɬɢɜɧɨɫɬɿ ɬɚ ɭɱɚɫɬɿ
• ɋɩɪɢɬɧɿɫɬɶ: Nine Hole Peg Test, Box & Block test, ɬɟɫɬ ɮɭɧɤɰɿʀ ɤɢɫɬɿ Jebsen-Taylor
• ȼɢɤɨɪɢɫɬɚɧɧɹ ɤɢɫɬɿ ɬɚ ɪɭɤɢ: Motor Activity Log, ABILHAND, Action Research Arm Test, Cochin Hand Scale, The
Disabilities of the Arm, Shoulder and Hand (DASH) Score ɬɚ ɿɧɲɿ ɲɤɚɥɢ.
• Ȼɚɥɚɧɫ: ɒɤɚɥɚ Ȼɚɥɚɧɫɭ Berg, Timed «Up and Go Test», Functional Reach Test, ɫɭɛɲɤɚɥɚ ɛɚɥɚɧɫɭ ɬɟɫɬɭ Fugl-Meyer, Postural
Assessment Scale for Stroke, ɫɬɚɬɢɱɧɚ ɬɚ ɞɢɧɚɦɿɱɧɚ ɩɨɫɬɭɪɨɝɪɚɮɿɹ, ɿɧɟɪɰɿɣɧɿ ɞɚɬɱɢɤɢ ɞɥɹ ɧɨɫɿɧɧɹ ɬɚ ɿɧɲɿ ɲɤɚɥɢ
ɜɢɤɨɧɚɧɧɹ
• Ɇɨɛɿɥɶɧɿɫɬɶ: Functional Ambulation Category, ɬɟɫɬ ɯɨɞɶɛɢ ɧɚ 10 ɦɟɬɪɿɜ, ɬɟɫɬ ɯɨɞɶɛɢ ɡɚ 6 ɯɜɢɥɢɧ, ɿɧɞɟɤɫ ɦɨɛɿɥɶɧɨɫɬɿ
Rivermead ɬɨɳɨ.
• Ⱥɤɬɢɜɧɿɫɬɶ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ: Health Assessment Questionnaire, ɿɧɞɟɤɫ Barthel, Functional Independence Measure
(FIM™)
• ȱɧɫɬɪɭɦɟɧɬɚɥɶɧɿ ɬɚ ɪɨɡɲɢɪɟɧɿ ɚɤɬɢɜɧɨɫɬɿ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ: ȱɧɞɟɤɫ ɚɤɬɢɜɧɨɫɬɟɣ Frenchay, ɒɤɚɥɚ ɚɤɬɢɜɧɨɫɬɟɣ
ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ Rivermead ɬɨɳɨ.
• Ⱥɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ: World Health Organization Disability Assessment Schedule II (WHODAS II), ɦɨɞɢɮɿɤɨɜɚɧɚ ɲɤɚɥɚ
Rankin, London Handicap Scale, Impact on Participation and Autonomy Questionnaire, Participation Profile, Participation Scale,
Keele Assessment of Participation, LIFE-H, EuroQol 5 ɬɚ ɿɧɲɿ ɲɤɚɥɢ ɫɚɦɨɨɰɿɧɤɢ.
• ɋɢɫɬɟɦɢ ɬɟɥɟɦɨɧɿɬɨɪɢɧɝɭ ɞɥɹ ɪɟɚɛɿɥɿɬɚɰɿʀ
• ȿɥɟɤɬɪɨɦɿɨɝɪɚɮɿɱɧɿ ɩɪɢɫɬɪɨʀ
• Ⱦɿɚɝɧɨɫɬɢɱɧɿ ɭɥɶɬɪɚɡɜɭɤɨɜɿ ɩɪɢɫɬɪɨʀ
• Ɋɨɛɨɬɚ: ɨɰɿɧɸɜɚɧɧɹ ɪɨɛɨɬɢ ɬɚ ɩɪɨɞɭɤɬɢɜɧɨʀ ɚɤɬɢɜɧɨɫɬɿ (ɜɤɥɸɱɚɸɱɢ ɨɰɿɧɤɭ ɮɭɧɤɰɿɨɧɚɥɶɧɨʀ ɡɞɚɬɧɨɫɬɿ ɬɚ ɚɧɚɥɿɡ ɦɿɫɰɹ
ɪɨɛɨɬɢ), ɨɩɢɬɭɜɚɥɶɧɢɤɢ ɞɥɹ ɫɚɦɨɫɬɿɣɧɨɝɨ ɡɚɩɨɜɧɟɧɧɹ (ɧɚɩɪ. Work Limitations Questionnaire, World Health Organization
Health and Work Performance Questionnaire, Workplace Activity Limitations Scale ɬɨɳɨ)
• Ɉɰɿɧɤɚ ɤɟɪɭɜɚɧɧɹ ɬɪɚɧɫɩɨɪɬɧɢɦ ɡɚɫɨɛɨɦ.
Ɉɰɿɧɸɜɚɧɧɹ ɤɨɧɬɟɤɫɬɭɚɥɶɧɢɯ ɮɚɤɬɨɪɿɜ ɬɚ ɩɨɬɪɟɛ
• ȼɿɞɩɨɜɿɞɧɿ ɮɚɤɬɨɪɢ ɫɟɪɟɞɨɜɢɳɚ: ɩɪɨɞɭɤɬɢ ɬɚ ɬɟɯɧɨɥɨɝɿʀ ɞɥɹ ɨɫɨɛɢɫɬɨɝɨ ɤɨɪɢɫɬɭɜɚɧɧɹ ɭ ɩɨɜɫɹɤɞɟɧɧɨɦɭ ɠɢɬɬɿ,
ɦɨɛɿɥɶɧɿɫɬɶ ɬɚ ɩɟɪɟɦɿɳɟɧɧɹ ɭ ɩɪɢɦɿɳɟɧɧɿ / ɧɚɡɨɜɧɿ; ɩɪɢɪɨɞɧɟ ɬɚ ɮɿɡɢɱɧɟ ɫɟɪɟɞɨɜɢɳɟ; ɩɿɞɬɪɢɦɤɚ ɡ ɛɨɤɭ ɪɨɞɢɧɢ, ɞɪɭɡɿɜ,
ɞɨɝɥɹɞɚɱɿɜ, ɝɪɨɦɚɞɢ, ɮɚɯɿɜɰɿɜ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ’ɹ, ɪɨɛɨɬɨɞɚɜɰɿɜ ɬɨɳɨ; ɫɬɚɜɥɟɧɧɹ ɥɸɞɟɣ ɬɚ ɫɭɫɩɿɥɶɫɬɜɚ, ɩɨɫɥɭɝɢ, ɫɢɫɬɟɦɢ
ɬɚ ɩɨɥɿɬɢɤɢ.
• Ɉɫɨɛɢɫɬɿ ɮɚɤɬɨɪɢ: ɫɩɨɫɿɛ ɠɢɬɬɹ, ɡɜɢɱɤɢ, ɨɫɜɿɬɚ, ɪɚɫɚ / ɟɬɧɨɫ, ɠɢɬɬɽɜɿ ɩɨɞɿʀ ɚɛɨ ɫɨɰɿɚɥɶɧɿ ɛɚɡɨɜɿ ɩɨɬɪɟɛɢ.
• ɉɨɬɪɟɛɢ ɜ ɨɛɥɚɞɧɚɧɧɿ, ɩɟɪɫɨɧɚɥɶɧɟ ɩɟɪɟɫɭɜɚɧɧɹ (ɧɚɩɪ. ɜɿɡɤɢ).
• ɉɨɬɪɟɛɢ ɜ ɚɞɚɩɬɚɰɿʀ ɫɟɪɟɞɨɜɢɳɚ (ɧɚɩɪ. ɩɪɨɠɢɜɚɧɧɹ).
• Ⱦɨɫɬɭɩ ɞɨ ɿɧɮɨɪɦɚɰɿɣɧɢɯ ɬɟɯɧɨɥɨɝɿɣ, ɦɟɞɢɱɧɚ ɝɪɚɦɨɬɧɿɫɬɶ.
Âñòàâêà 3. – Ïðèêëàä äëÿ òåñòóâàííÿ ôóíêö³é Ɋɟɡɭɥɶɬɚɬɢ ɨɰɿɧɸɜɚɧɧɹ ɛɭɥɢ ɨɛɝɨɜɨɪɟɧɿ ɧɚ ɡɛɨɪɚɯ
òà çäàòíîñò³, à òàêîæ áàãàòîâèì³ðíîãî ɤɨɦɚɧɞɢ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ ɫɩɿɥɶɧɨ ɡ
îö³íþâàííÿ ôóíêö³îíóâàííÿ ɩɚɰɿɽɧɬɨɦ ɬɚ ɩɿɞ ɤɟɪɿɜɧɢɰɬɜɨɦ ɥɿɤɚɪɹ ɎɊɆ. Ɂɪɨɛɥɟɧɨ
ɜɢɫɧɨɜɨɤ, ɳɨ 6-ɬɢɠɧɟɜɚ ɦɭɥɶɬɢ-ɩɪɨɮɟɫɿɣɧɚ ɪɟɚɛɿɥɿɬɚɰɿɹ,
55-ɪɿɱɧɢɣ ɱɨɥɨɜɿɤ ɡ ɯɜɨɪɨɛɨɸ ɉɚɪɤɿɧɫɨɧɚ ɜɿɞɜɿɞɚɜ ɜɤɥɸɱɚɸɱɢ ɮɿɡɢɱɧɭ ɬɟɪɚɩɿɸ, ɟɪɝɨɬɟɪɚɩɿɸ, ɩɫɢɯɨɬɟɪɚɩɿɸ,
ɚɦɛɭɥɚɬɨɪɧɢɣ ɡɚɤɥɚɞ ɡ ɦɭɥɶɬɢ-ɩɪɨɮɟɫɿɣɧɨɸ ɤɨɦɚɧɞɨɸ ɦɨɠɟ ɩɨɤɪɚɳɢɬɢ ɡɚɝɚɥɶɧɭ ɩɪɢɞɚɬɧɿɫɬɶ ɿ ɩɪɚɰɟɡɞɚɬɧɿɫɬɶ
ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ. ȼɿɧ ɛɭɜ ɫɤɟɪɨɜɚɧɢɣ ɩɚɰɿɽɧɬɚ. Ȼɭɥɨ ɜɢɡɧɚɧɨ ɪɟɚɥɿɫɬɢɱɧɢɦ, ɳɨ ɩɚɰɿɽɧɬ ɦɨɠɟ
ɣɨɝɨ ɫɿɦɟɣɧɢɦ ɥɿɤɚɪɟɦ, ɞɥɹ ɨɰɿɧɸɜɚɧɧɹ, ɱɢ ɦɨɠɭɬɶ ɩɨɜɟɪɧɭɬɢɫɹ ɞɨ ɪɨɛɨɬɢ, ɚɥɟ, ɧɚɣɿɦɨɜɿɪɧɿɲɟ, ɡɿ ɫɤɨɪɨɱɟɧɢɦ
ɞɨɞɚɬɤɨɜɿ ɪɟɚɛɿɥɿɬɚɰɿɣɧɿ ɜɬɪɭɱɚɧɧɹ ɩɨɥɿɩɲɢɬɢ ɣɨɝɨ ɳɨɞɟɧɧɢɦ ɪɨɛɨɱɢɦ ɱɚɫɨɦ. ɉɚɰɿɽɧɬ ɛɭɜ ɩɪɨɿɧɫɬɪɭɤɬɨɜɚɧɢɣ
ɩɨɜɫɹɤɞɟɧɧɭ ɚɤɬɢɜɧɿɫɬɶ, ɿ ɱɢ ɜɿɧ ɦɚɽ ɦɨɠɥɢɜɿɫɬɶ ɳɨɞɨ ɬɨɝɨ, ɞɟ ɬɚ ɹɤ ɩɨɞɚɜɚɬɢ ɡɚɹɜɤɭ ɧɚ ɫɨɰɿɚɥɶɧɭ
ɩɨɜɟɪɧɭɬɢɫɶ ɞɨ ɪɨɛɨɬɢ ɩɿɫɥɹ ɩɪɨɮɟɫɿɣɧɨʀ ɪɟɚɛɿɥɿɬɚɰɿʀ. ɤɨɦɩɟɧɫɚɰɿɸ ɬɚ ɩɪɨɝɪɚɦɭ ɿɧɬɟɝɪɚɰɿʀ ɞɨ ɪɨɛɨɬɢ ɡ ɧɟɩɨɜɧɢɦ
ɉɿɫɥɹ ɤɥɿɧɿɱɧɨɝɨ ɨɛɫɬɟɠɟɧɧɹ ɥɿɤɚɪɟɦ ɎɊɆ ɩɚɰɿɽɧɬ ɪɨɛɨɱɢɦ ɞɧɟɦ.
ɡɚɩɨɜɧɢɜ ɧɚɛɿɪ ɨɰɿɧɸɜɚɥɶɧɢɯ ɚɧɤɟɬ, ɜɤɥɸɱɚɸɱɢ Pain
Disability Scale, Multidimensional Assessment of Fatigue Scale,
Hospital Anxiety Depression Scale, Unified Parkinson Disease ð³çíèõ ì’ÿçîâî-ñêåëåòíèõ ä³ëÿíîê, ùî âèçíà÷àþòü-
Rating Scale ɬɚ Medical Outcomes Study Short Form 36 ɬɚ ñÿ ðåíòãåí³âñüêèìè ³ ³íøèìè ìåòîäàìè â³çóàë³çàö³¿,
Work Ability Index. ñòðóêòóðí³ ïîðóøåííÿ ãîëîâíîãî, àáî ñïèííîãî
ȼɿɞɩɨɜɿɞɧɨ ɞɨ ȯɜɪɨɩɟɣɫɶɤɢɯ ɧɚɫɬɚɧɨɜ ɡ ɮɿɡɢɱɧɨʀ ɬɟɪɚɩɿʀ
ɩɪɢ ɯɜɨɪɨɛɿ ɉɚɪɤɿɧɫɨɧɚ, ɮɿɡɢɱɧɢɣ ɬɟɪɚɩɟɜɬ ɨɰɿɧɢɥɚ ɮɭɧɤɰɿʀ ìîçêó, ùî ïðîäåìîíñòðîâàí³ ç âèêîðèñòàííÿì ð³çíèõ
ɨɪɝɚɧɿɡɦɭ ɬɚ ɚɤɬɢɜɧɨɫɬɿ ɬɚɤɿ, ɹɤ ɛɚɥɚɧɫ, ɬɨɥɟɪɚɧɬɧɿɫɬɶ ɞɨ ìåòîä³â â³çóàë³çàö³¿, òà ïðîëåæí³ º ïðèêëàäàìè ïî-
ɮɿɡɢɱɧɨɝɨ ɧɚɜɚɧɬɚɠɟɧɧɹ, ɡɦɿɧɚ ɨɫɧɨɜɧɢɯ ɩɨɥɨɠɟɧɶ ɬɿɥɚ ɬɚ ðóøåíü ñòðóêòóð îðãàí³çìó, ÿê³ çàçâè÷àé îö³íþþòü-
ɯɨɞɶɛɚ. ȼɨɧɚ ɩɪɨɜɟɥɚ ɬɟɫɬ Ɍimed-up and go ɬɚ ɚɧɚɥɿɡ ɯɨɞɢ.
ȿɪɝɨɬɟɪɚɩɟɜɬ ɨɰɿɧɢɜ ɮɭɧɤɰɿɸ ɤɿɫɬɿ ɿɡ ɡɚɫɬɨɫɭɜɚɧɧɹɦ Nine- ñÿ â ñôåð³ ÔÐÌ. Ôóíêö³¿ òà ñòðóêòóðè îðãàí³çìó
hole-peg test ɬɚ ɜɢɤɨɧɚɧɧɹ ɩɨɜɫɹɤɞɟɧɧɢɯ ɚɤɬɢɜɧɨɫɬɟɣ, ɬɚɤɢɯ, ìîæëèâî îö³íþâàòè ç âèêîðèñòàííÿì àíàìíåçó,
ɹɤ ɜɢɤɨɪɢɫɬɚɧɧɹ ʀɠɿ, ɤɨɪɢɫɬɭɜɚɧɧɹ ɬɭɚɥɟɬɨɦ, ɤɨɪɢɫɬɭɜɚɧɧɹ ô³çèêàëüíîãî îáñòåæåííÿ, ëàáîðàòîðíèõ äîñë³ä-
ɨɞɹɝɨɦ ɬɚ ɜɡɭɬɬɹɦ ɬɚ ɦɢɬɬɹ. Ⱦɨɞɚɬɤɨɜɨ, ɜɿɧ ɨɰɿɧɢɜ ɮɭɧɤɰɿʀ, æåíü, ìåòîä³â â³çóàë³çàö³¿, äåÿêèõ êë³í³÷íèõ, åëåê-
ɩɨɜ'ɹɡɚɧɿ ɡ ɣɨɝɨ ɩɪɨɮɟɫɿɣɧɨɸ ɭɱɚɫɬɸ, ɹɤ ɚɞɦɿɧɿɫɬɪɚɬɨɪɚ, ɬɚɤɿ
ɹɤ ɩɢɫɚɧɧɹ, ɜɢɤɨɪɢɫɬɚɧɧɹ ɤɨɦɩ'ɸɬɟɪɚ ɬɚ ɤɨɪɢɫɬɭɜɚɧɧɹ òðîô³ç³îëîã³÷íèõ îáñòåæåíü ÷è íåéðîïñèõîëîã³÷íèõ
ɩɚɩɟɪɨɜɢɦɢ ɮɚɣɥɚɦɢ. ɉɫɢɯɨɥɨɝ ɩɟɪɟɜɿɪɢɜ ɡɞɚɬɧɿɫɬɶ ɞɨ òåñò³â àáî îïèòóâàëüíèê³â äëÿ ñàìîñò³éíîãî çàïîâ-
ɤɨɧɰɟɧɬɪɚɰɿʀ ɬɚ ɜɢɜɱɢɜ ɩɫɢɯɿɱɧɿ ɩɪɨɛɥɟɦɢ. ɇɚɪɟɲɬɿ, ɚɥɟ ɧɟ íåííÿ. Ïðèêëàäàìè ³íñòðóìåíò³â îö³íþâàííÿ
ɦɟɧɲ ɜɚɠɥɢɜɨ, ɫɨɰɿɚɥɶɧɢɣ ɩɪɚɰɿɜɧɢɤ ɜɢɜɱɢɜ ɫɨɰɿɚɥɶɧɭ
ɫɢɬɭɚɰɿɸ ɩɚɰɿɽɧɬɚ ɬɚ ɦɨɠɥɢɜɨɫɬɿ ɫɨɰɿɚɥɶɧɨʀ ɤɨɦɩɟɧɫɚɰɿʀ ɬɚ ôóíêö³é îðãàí³çìó, ÿê³ øèðîêî âèêîðèñòîâóþòüñÿ,
ɚɞɚɩɬɚɰɿʀ ɪɨɛɨɱɨɝɨ ɦɿɫɰɹ. º Beck Depression Inventory äëÿ äåïðåñ³¿, Mini

122 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 7 – ÑÔÅÐÀ Ê˲Ͳ×ÍÈÕ ÊÎÌÏÅÒÅÍÒÍÎÑÒÅÉ: ÔÐÌ ÍÀ ÏÐÀÊÒÈÖ²
Mental State Examination äëÿ äåÿêèõ êîãí³òèâíèõ
ôóíêö³é òà Modified Ashworth Scale äëÿ îö³íþâàí-
íÿ ì’ÿçîâîãî òîíóñó27.
˳êàð³ ÔÐÌ ìîæóòü òàêîæ âèêîðèñòîâóâàòè
ñòàíäàðòèçîâàí³ òåõí³÷í³ îö³íþâàííÿ âèêîíàííÿ,
òàê³ ÿê àíàë³ç õîäüáè, äèíàìîìåòð³ÿ ì’ÿç³â òà
³íøèõ ðóõîâèõ ôóíêö³é.  ïðîöåñ³ ô³çè÷íî¿ òà ðåà-
á³ë³òàö³éíî¿ ìåäèöèíè ïðè ðîáîò³ ç ïàö³ºíòàìè ç
ïåâíèìè ñòàíàìè ìîæóòü çíàäîáèòèñÿ ñïåö³àë³çî-
âàí³ ä³àãíîñòè÷í³ ìåòîäè îö³íþâàííÿ, íàïð. îö³í-
êà äèñôà㳿 ïðè ³íñóëüò³, åëåêòðîä³àãíîñòè÷í³ òåñ-
òè ïðè ïîøêîäæåíí³ ïåðèôåðè÷íèõ íåðâ³â,
óðîäèíàì³÷í³ âèì³ðþâàííÿ ïðè ïîøêîäæåííÿõ
ñïèííîãî ìîçêó àáî òåñòè îö³íþâàííÿ êîãí³òèâíèõ
ôóíêö³é ïðè ÷åðåïíî-ìîçêîâ³é òðàâì³1,2.
«Àêòèâí³ñòü òà ó÷àñòü» ïðåäñòàâëåí³ â 9 äîìå-
íàõ, ÿê ºäèíèé ñïèñîê â ÌÊÔ5. Àêòèâí³ñòü – öå
îñíîâí³ çàâäàííÿ ÷è 䳿, ùî ïðåäñòàâëÿþòü ³íäè-
â³äóàëüíó ïåðñïåêòèâó ôóíêö³îíóâàííÿ.  ô³çè÷í³é
òà ðåàá³ë³òàö³éí³é ìåäèöèí³ áóëî á ðîçóìíî îïåðà-
ö³îí³çóâàòè «àêòèâí³ñòü», ÿê îêðåìèé ð³âåíü îö³íþ-
âàííÿ. Ó öüîìó âèïàäêó â ÿêîñò³ «àêòèâíîñò³»
ìîæóòü ðîçãëÿäàòèñÿ äîìåíè: íàâ÷àííÿ òà çàñòî-
ñóâàííÿ çíàíü, çàãàëüí³ çàâäàííÿ òà ïîòðåáè,
ñï³ëêóâàííÿ, ìîá³ëüí³ñòü, ñàìîîáñëóãîâóâàííÿ òà,
ïåâíîþ ì³ðîþ, æèòòÿ âäîìà. «Ó÷àñòü» ïðåäñòàâ-
ëÿº ñóñï³ëüíó ïåðñïåêòèâó ôóíêö³îíóâàííÿ òà âêëþ-
÷ຠì³æîñîáèñò³ñí³ âçàºìî䳿 òà âçàºìèíè, æèòòºâ³
çàõîäè, òàê³ ÿê æèòòÿ âäîìà, îñâ³òà, ðîáîòà òà çàé-
íÿò³ñòü, ãðîìàäñüêå, ñîö³àëüíå òà öèâ³ëüíå æèò-
òÿ28. Òåðì³í «ôóíêö³îíàëüíå îö³íþâàííÿ», ùî âè-
êîðèñòîâóºòüñÿ â ìåäè÷í³é ë³òåðàòóð³, â³äïîâ³äàº
îö³íþâàííþ «àêòèâíîñò³ òà ó÷àñò³». Ìîæíà îö³-
íþâàòè âèêîíàííÿ, îïèñóþ÷è òå, ùî ðîáèòü îñî-
áà â éîãî íèí³øíüîìó ñåðåäîâèù³, àáî çäàòí³ñòü,
ÿêà îïèñóº ìîæëèâ³ñòü ïåðñîíè âèêîíóâàòè çàâ-
äàííÿ àáî ä³þ, ³ öå îö³íþâàííÿ ñë³ä âèêîíóâàòè â
«ñòàíäàðòèçîâàíîìó» ñåðåäîâèù³28. Õî÷à ñïîñòå-
ð³ãàþòüñÿ êîðåëÿö³¿ ì³æ çäàòí³ñòþ ³ âèêîíàííÿì,
êîëèâàþòüñÿ â³ä ïîì³ðíèõ äî âèñîêèõ, ôàêòîðè
ñåðåäîâèùà òà îñîáèñò³ ôàêòîðè (òàê³, ÿê ìîòè-
âàö³ÿ) ìàþòü çíà÷íèé âïëèâ íà âèêîíàííÿ àêòèâ-
íîñòåé29.
Îö³íþâàííÿ àêòèâíîñò³ òà ó÷àñò³ ìîæå áóòè
çä³éñíåíî çà äîïîìîãîþ ð³çíèõ ìåòîä³â, ùî âêëþ-
÷àþòü áåçïîñåðåäíº îïèòóâàííÿ ôóíêö³îíàëüíî-
ãî àíàìíåçó, ñïîñòåðåæåííÿ çà àêòèâí³ñòþ, âèêî-
ðèñòàííÿ ñòàíäàðòèçîâàíèõ ôóíêö³îíàëüíèõ øêàë
(îïèòóâàííÿ ùîäî àêòèâíîñò³ ïîâñÿêäåííîãî æèò-
òÿ, ³íñòðóìåíòàëüíà àêòèâí³ñòü ïîâñÿêäåííîãî
æèòòÿ, êîãí³òèâíå ôóíêö³îíóâàííÿ, ó÷àñòü òîùî)
àáî ñïåö³àëüí³ òåñòè âèêîíàííÿ, òàê³, ÿê
ñïðèòí³ñòü, ð³âíîâàãà àáî õîäüáà. Á³ëüø³ñòü
³íñòðóìåíò³â îö³íþâàííÿ, ùî âèêîðèñòîâóþòüñÿ
ó ñôåð³ ÔÐÌ, îö³íþþòü àêòèâí³ñòü 30,31. Îö³íþ-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
âàííÿ ìîæå çîñåðåäæóâàòèñÿ íà ñïåö³àëüí³é àê-
òèâíîñò³, òàê³é, ÿê ìîá³ëüí³ñòü àáî ñïðèòí³ñòü,
àáî ïîºäíàííÿ òàêèõ àêòèâíîñòåé. Íàïðèêëàä,
Rivermead Mobility Index îö³íþº ìîá³ëüí³ñòü, òîä³,
ÿê Nine Hole Peg Test îö³íþº ñïðèòí³ñòü. ²íäåêñ
Áàðòåëà ³ Functional Independence Measure (FIM™)
çàçâè÷àé âèêîðèñòîâóþòü çàãàëüí³ øêàëè îáìå-
æåíü àêòèâíîñò³, ïåðøèé îö³íþº ô³çè÷íó àêòèâí³ñòü
ó ïîâñÿêäåííîìó æèòò³, îñòàíí³é îö³íþº ÿê ô³çè÷í³,
òàê ³ ï³çíàâàëüí³ àñïåêòè ïîâñÿêäåííîãî æèòòÿ32
(êîìïëåêñíèé ñïèñîê îïèòóâàëüíèê³â ³ ³íøèõ
³íñòðóìåíò³â êîìïëåêñíîãî îö³íþâàííÿ, ùî âèêî-
ðèñòîâóþòüñÿ â ÔÐÌ, íàâåäåííèé ó Äîäàòêó 3).
Ôàêòîðè ñåðåäîâèùà òà îñîáèñò³ ôàêòîðè, ÷å-
ðåç ¿õ âïëèâ íà ôóíêö³îíóâàííÿ, áåçóìîâíî, ïî-
âèíí³ îö³íþâàòèñü â ïðîöåñ³ ÔÐÌ, ÿê áàð’ºðè àáî
ñïðèÿòëèâ³ ÷èííèêè. Îö³íþâàííÿ ôàêòîð³â ñåðå-
äîâèùà ìîæå áóòè ðîçãëÿíóòî â³äïîâ³äíî äî
ñòðóêòóðè ÌÊÔ, äå âîíè ïåðåðàõîâàí³ â ï’ÿòè
ðîçä³ëàõ, ÿê ïðîäóêòè ³ òåõíîëî㳿, ïðèðîäíå ñå-
ðåäîâèùå ³ àíòðîïîãåíí³ çì³íè ñåðåäîâèùà,
ï³äòðèìêà ³ â³äíîñèíè, ñòàâëåííÿ, ïîñëóãè, ñèñòå-
ìè ³ ïîë³òèêà5. Íåîáõ³äíî òàêîæ çàçíà÷èòè òàê³
îñîáèñò³ ôàêòîðè, ÿê ñïîñ³á æèòòÿ, çâè÷êè, îñâ³-
òà, ðàñà/åòí³÷í³ñòü, æèòòºâ³ ïî䳿 àáî ñîö³àëüí³
ïåðåäóìîâè, õî÷à âîíè íå âõîäÿòü äî ÌÊÔ.
³äïîâ³äí³ êîíòåêñòóàëüí³ ôàêòîðè â³äíîñíî äî
ñîö³àëüíîãî òà ô³çè÷íîãî ñåðåäîâèùà îö³íþþòü-
ñÿ øëÿõîì îïèòóâàííÿ àáî ñòàíäàðòèçîâàíèìè
êîíòðîëüíèìè òåñòàìè íà îñíîâ³ ÌÊÔ. Äëÿ âèç-
íà÷åííÿ îñîáèñòèõ ôàêòîð³â ìîæóòü áóòè âèêî-
ðèñòàí³ ñòàíäàðòèçîâàí³ àíêåòè (íàïð. îö³íêà
ñòðàòåã³é ïîäîëàííÿ ñèòóàö³¿)18.
Õî÷à ìåäè÷íå òà ôóíêö³îíàëüíå îö³íþâàííÿ
(îö³íþâàííÿ ôóíêö³îíóâàííÿ) â ö³é ãëàâ³ ðîçãëÿ-
äàþòüñÿ îêðåìî, â ÌÊÔ äîáðå âñòàíîâëåíà äâî-
á³÷íà âçàºìîä³ÿ ì³æ ñòàíîì çäîðîâ’ÿ òà ôóíêö³î-
íàëüíèìè âëàñòèâîñòÿìè5. Âïëèâ ñòàíó çäîðîâ’ÿ
íà ôóíêö³îíóâàííÿ º áåççàïåðå÷íèì, ³ ôóíêö³îíó-
âàííÿ º íåâ³ä’ºìíîþ ÷àñòèíîþ íàøîãî ñïðèéíÿò-
òÿ çäîðîâ’ÿ33. Âñåñâ³òíÿ îðãàí³çàö³ÿ îõîðîíè çäî-
ðîâ’ÿ ïðàãíå ³íòåãðàö³¿ ÌÊÕ òà ÌÊÔ ï³ä ÷àñ
ïðîöåñó ïåðåãëÿäó ÌÊÕ (ÌÊÕ-Õ²)34. Ñï³ëüíå âè-
êîðèñòàííÿ ÌÊÕ òà ÌÊÔ â ÌÊÕ-Õ² äàñòü äî-
ñòóïí³ñòü äî ö³ë³ñíî¿ ³íôîðìàö³¿ ùîäî ìåäè÷íîãî
ä³àãíîçó òà éîãî âïëèâó íà ôóíêö³îíóâàííÿ (íàïð.
ôóíêö³îíàëüíå îö³íþâàííÿ) îäíî÷àñíî â çàãàëüí³é
ñòðóêòóð³35.
Âòðó÷àííÿ â ô³çè÷í³é òà ðåàá³ë³òàö³éí³é
ìåäèöèí³
Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà âèêîðèñ-
òîâóº øèðîêèé ñïåêòð á³îìåäè÷íèõ òà òåõíîëî-
ã³÷íèõ âòðó÷àíü. Âòðó÷àííÿ ÔÐÌ, ÿê³ â³äïîâ³äàþòü
123
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

̳æíàðîäí³é êëàñèô³êàö³¿ âòðó÷àíü â îõîðîíè çäî-
ðîâ’ÿ (ICHI) (çàðàç ðîçðîáëÿºòüñÿ)36, âêëþ÷àþòü
ìåäè÷í³ âòðó÷àííÿ (íàïð. ìåäèêàìåíòîçíå ë³êó-
âàííÿ òà ïðàêòè÷í³ ïðîöåäóðè), ô³çè÷íå ë³êóâàí-
íÿ òà ô³ç³îòåðàï³þ, åðãîòåðàï³þ, òåðàï³þ ìîâè òà
ìîâëåííÿ, ìåíåäæìåíò äèñôà㳿, íåéðîïñèõî-
ëîã³÷í³ ³íòåðâåíö³¿, ïñèõîëîã³÷í³ âòðó÷àííÿ (âêëþ-
÷àþ÷è êîíñóëüòóâàííÿ ïàö³ºíò³â, ðîäèí òà äîãëÿ-
äà÷³â), 䳺òîòåðàï³þ, äîïîì³æí³ òåõíîëî㳿,
ïðîòåçóâàííÿ, îðòåçóâàííÿ, òåõí³÷í³ òà äîïîì³æí³
çàñîáè, íàâ÷àííÿ ïàö³ºíò³â, òà ìåäñåñòðèíñòâî
â ÔÐÌ/ðåàá³ë³òàö³¿ (Âñòàâêà 4). Á³ëüø äåòàëü-
íà ³íôîðìàö³ÿ íàâåäåíà â Òàáëèö³ IV (êîìïëåê-
ñíèé ïåðåë³ê âòðó÷àíü ìîæå áóòè çíàéäåíèé ó
Äîäàòêó 4).
Çðîñòàþòü íàóêîâ³ äîêàçè åôåêòèâíîñò³ òà ðå-
çóëüòàòèâíîñò³ á³ëüøîñò³ çàñòîñîâàíèõ âòðó÷àíü.
Íîâà Êîêðàí³âñüêà ðåàá³ë³òàö³éíà ñôåðà ìຠçà
ìåòó áóòè ìîñòîì ì³æ íàÿâíèìè äîêàçàìè òà ñôå-
ðîþ ïðàêòè÷íî¿ ä³ÿëüíîñò³ ô³çè÷íî¿ òà ðåàá³ë³òà-
ö³éíî¿ ìåäèöèíè (http://rehabilitation.cochrane.org/).
Âñòàâêà 4. – Ïðèêëàä ë³êóâàííÿ ïàö³ºíòà ç öóêðîâèì
ä³àáåòîì, ÿêèé ë³êóºòüñÿ çà ïðîãðàìîþ ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
52-ɪɿɱɧɢɣ ɱɨɥɨɜɿɤ ɿɡ ɰɭɤɪɨɜɢɦ ɞɿɚɛɟɬɨɦ 2 ɬɢɩɭ ɿ ɝɚɧɝɪɟ-
ɧɨɸ ɫɬɨɩ ɩɟɪɟɧɿɫ ɬɪɚɧɫɬɿɛɿɚɥɶɧɭ ɚɦɩɭɬɚɰɿɸ. ȼɿɧ ɨɬɪɢɦɚɜ
ɩɟɪɟɞɨɩɟɪɚɰɿɣɧɟ ɤɨɧɫɭɥɶɬɭɜɚɧɧɹ, ɹɤɟ ɞɨɡɜɨɥɢɥɨ ɣɨɦɭ ɫɩɪɚ-
ɜɢɬɢɫɶ ɡ ɦɚɣɛɭɬɧɿɦɢ ɡɦɿɧɚɦɢ ɜ ɣɨɝɨ ɬɿɥɿ ɬɚ ɫɩɨɫɨɛɿ ɠɢɬɬɹ.
ɐɟ ɜɤɥɸɱɚɥɨ ɡɚɯɨɞɢ, ɳɨ ɩɿɞɝɨɬɭɜɚɥɢ ɣɨɝɨ ɞɨ ɛɨɪɨɬɶɛɢ ɡɿ
ɡɦɿɧɚɦɢ ɱɭɬɥɢɜɨɫɬɿ, ɜɢɝɥɹɞɨɦ ɬɿɥɚ ɬɚ ɩɨɪɭɲɟɧɧɹɦɢ ɛɚɥɚɧɫɭ
ɿ ɞɨɡɜɨɥɢɥɢ ɣɨɦɭ ɡɚɣɦɚɬɢɫɹ ɪɟɚɛɿɥɿɬɚɰɿɽɸ.
Ɏɿɡɢɱɧɚ ɬɟɪɚɩɿɹ ɩɨɱɚɥɚɫɹ ɩɪɨɬɹɝɨɦ ɪɚɧɧɶɨʀ ɩɿɫɥɹ ɨɩɟɪɚ-
ɰɿɣɧɨʀ ɮɚɡɿ ɡ ɞɢɯɚɥɶɧɨʀ ɬɟɪɚɩɿʀ ɬɚ ɩɪɨɮɿɥɚɤɬɢɤɢ ɬɪɨɦɛɨɡɭ ɬɚ
ɤɨɧɬɪɚɤɬɭɪ. ɍɜɚɝɚ ɛɭɥɚ ɩɪɢɞɿɥɟɧɚ ɮɨɪɦɭɜɚɧɧɸ ɚɞɟɤɜɚɬɧɨʀ
ɤɭɤɫɢ ɡ ɩɟɪɟɜ'ɹɡɤɚɦɢ ɬɚ ɡɦɟɧɲɟɧɧɸ ɧɚɛɪɹɤɭ ɤɭɤɫɢ. ȼɿɧ
ɩɨɱɚɜ ɯɨɞɢɬɢ ɡ ɬɢɦɱɚɫɨɜɢɦ ɩɪɨɬɟɡɨɦ ɿ ɛɭɥɢ ɩɪɨɜɟɞɟɧɿ ɜɢɦɿ-
ɪɢ ɞɥɹ ɩɨɫɬɿɣɧɨɝɨ. ɐɟ ɛɭɥɨ ɡɪɨɛɥɟɧɨ ɡ ɨɛɝɨɜɨɪɟɧɧɹɦ ɡ ɩɚɰɿ-
ɽɧɬɨɦ ɳɨɞɨ ɪɿɜɧɹ ɬɚ ɯɚɪɚɤɬɟɪɭ ɣɨɝɨ ɮɿɡɢɱɧɢɯ ɜɢɦɨɝ ɿ ɰɿɥɟɣ.
Ȼɭɥɚ ɡɜɟɪɧɭɬɚ ɭɜɚɝɚ ɧɚ ɦɨɠɥɢɜɿ ɩɨɬɪɟɛɢ ɭ ɚɞɚɩɬɚɰɿʀ ɜɞɨɦɚ,
ɧɚ ɪɨɛɨɱɨɦɭ ɦɿɫɰɿ ɚɛɨ ɦɚɲɢɧɿ. Ȼɭɜ ɜɢɜɱɟɧɢɣ ɣɨɝɨ ɲɥɹɯ ɞɨ
ɩɚɪɤɿɧɝɭ ɧɚ ɪɨɛɨɬɿ, ɞɢɫɬɚɧɰɿɹ, ɹɤɭ ɩɪɨɯɨɞɢɬɶ ɩɚɰɿɽɧɬ ɧɚ
ɪɨɛɨɬɿ ɬɚ ɿɧɲɿ ɜɿɞɩɨɜɿɞɧɿ ɮɚɤɬɨɪɢ, ɬɚɤɿ, ɹɤ ɞɨɡɜɿɥɥɹ ɬɚ ɫɿɦɟɣ-
ɧɿ ɡɚɯɨɞɢ. ɉɚɰɿɽɧɬɚ ɧɚɜɱɚɥɢ ɩɪɚɜɢɥɚɦ ɞɨɝɥɹɞɭ ɡɚ ɤɭɤɫɨɸ ɬɚ
ɩɪɨɬɟɡɚɦɢ. ɑɟɪɟɡ ɬɪɢ ɦɿɫɹɰɿ ɩɿɫɥɹ ɚɦɩɭɬɚɰɿʀ ɜɿɧ ɛɭɜ ɧɟɡɚ-
ɥɟɠɧɢɦ ɭ ɫɚɦɨɨɛɫɥɭɝɨɜɭɜɚɧɧɿ, ɜɤɥɸɱɚɸɱɢ ɫɩɨɫɬɟɪɟɠɟɧɧɹ
ɣɨɝɨ ɡɚɥɢɲɤɨɜɨʀ ɤɿɧɰɿɜɤɢ. ȼɿɧ ɡɦɿɝ ɩɨɜɟɪɧɭɬɢɫɹ ɞɨ ɪɨɛɨɬɢ,
ɿ ɛɭɞɟ ɩɟɪɟɛɭɜɚɬɢ ɩɿɞ ɧɚɝɥɹɞɨɦ ɞɨ ɤɿɧɰɹ ɠɢɬɬɹ.

Òàáëèöÿ IV. Âòðó÷àííÿ â ô³çè÷í³é òà ðåàá³ë³òàö³éí³é ìåäèöèí³

Ɇɟɞɢɱɧɿ ɜɬɪɭɱɚɧɧɹ Ɇɟɞɢɤɚɦɟɧɬɨɡɧɟ ɥɿɤɭɜɚɧɧɹ, ɫɩɪɹɦɨɜɚɧɟ ɧɚ ɜɿɞɧɨɜɥɟɧɧɹ ɚɛɨ ɩɨɥɿɩɲɟɧɧɹ ɫɬɪɭɤɬɭɪ ɬɚ/ɚɛɨ ɮɭɧɤɰɿɣ ɨɪɝɚɧɿɡɦɭ,
ɧɚɩɪ. ɡɧɟɛɨɥɸɜɚɥɶɧɚ ɬɟɪɚɩɿɹ, ɩɪɨɬɢɡɚɩɚɥɶɧɚ ɬɟɪɚɩɿɹ, ɪɟɝɭɥɹɰɿɹ ɦ'ɹɡɨɜɨɝɨ ɬɨɧɭɫɭ, ɩɨɥɿɩɲɟɧɧɹ ɡɞɨɪɨɜ’ɹ
ɤɿɫɬɨɤ, ɥɿɤɭɜɚɧɧɹ ɞɟɩɪɟɫɿʀ ɬɨɳɨ.
ɉɪɚɤɬɢɱɧɿ ɩɪɨɰɟɞɭɪɢ, ɧɚɩɪ. ɿɧ’ɽɤɰɿʀ (ɧɚɩɪ. ɚɧɟɫɬɟɬɢɤɿɜ, ɤɨɪɬɢɤɨɫɬɟɪɨʀɞɿɜ, ɜɧɭɬɪɿɲɧɶɨɫɭɝɥɨɛɨɜɿ ɿɧ’ɽɤɰɿʀ
ɝɿɚɥɭɪɨɧɨɜɨʀ ɤɢɫɥɨɬɢ, ɚɛɨ ɟɩɿɞɭɪɚɥɶɧɿ ɿɧ’ɽɤɰɿʀ, ɚɛɨ ɿɧ’ɽɤɰɿʀ ɭ ɬɪɢɝɟɪɧɿ ɬɨɱɤɢ, ɜɜɟɞɟɧɧɹ ɛɨɬɭɥɨɬɨɤɫɢɧɭ),
ɧɟɣɪɨɬɟɪɚɩɿɹ, ɪɟɝɟɧɟɪɚɬɢɜɧɚ ɿɧ’ɽɤɰɿɣɧɚ ɬɟɪɚɩɿɹ (ɧɚɩɪ. ɩɪɨɥɨɬɟɪɚɩɿɹ ɡ ɞɟɤɫɬɪɨɡɨɸ, ɩɥɚɡɦɚ, ɡɛɚɝɚɱɟɧɚ
ɬɪɨɦɛɨɰɢɬɚɦɢ), ɛɥɨɤɚɞɢ ɧɟɪɜɿɜ ɬɚ ɿɧɲɿ ɦɟɬɨɞɢ ɜɜɟɞɟɧɧɹ ɥɿɤɚɪɫɶɤɢɯ ɡɚɫɨɛɿɜ (ɧɚɩɪ. ɿɨɧɨɮɨɪɟɡ, ɮɨɧɨɮɨɪɟɡ,
ɜɢɤɨɪɢɫɬɚɧɧɹ ɿɧɬɪɚɬɟɤɚɥɶɧɢɯ ɩɨɦɩ ɞɥɹ ɜɜɟɞɟɧɧɹ ɛɚɤɥɨɮɟɧɭ ɬɨɳɨ).
ȼɬɪɭɱɚɧɧɹ ɎɊɆ ɡ ɮɿɡɢɱɧɢɦɢ Ʉɿɧɟɡɿɨɬɟɪɚɩɿɹ ɬɚ ɬɟɪɚɩɟɜɬɢɱɧɿ ɜɩɪɚɜɢ
ɚɝɟɧɬɚɦɢ ɬɚ ɬɟɪɚɩɟɜɬɢɱɧɢɦɢ Ɍɟɯɧɿɤɢ ɧɟɣɪɨɮɚɫɿɥɿɬɚɰɿʀ, ɧɚɩɪ. ɧɟɣɪɨɪɨɡɜɢɬɤɨɜɿ ɜɬɪɭɱɚɧɧɹ (ɧɚɩɪ. ɩɿɞɯɨɞɢ Bobath, Brunnstrom),
ɜɩɪɚɜɚɦɢ ɩɪɨɩɪɿɨɰɟɩɬɢɜɧɚ ɧɟɣɪɨɦ’ɹɡɨɜɚ ɮɚɫɿɥɿɬɚɰɿɹ ɿ ɬɟɪɚɩɿɹ ɡ ɫɟɧɫɨɪɧɨʀ ɿɧɬɟɝɪɚɰɿʀ, ɚ ɬɚɤɨɠ ɩɪɚɤɬɢɤɚ ɩɨɜɬɨɪɸɜɚɧɢɯ
ɡɚɜɞɚɧɶ (ɧɚɩɪ. ɬɟɪɚɩɿɹ ɩɪɢɦɭɫɨɜɢɦɢ ɪɭɯɚɦɢ)
Ɍɟɯɧɿɤɢ ɦɚɧɭɚɥɶɧɨʀ ɬɟɪɚɩɿʀ ɞɥɹ ɡɜɨɪɨɬɧɨ ɫɤɭɬɢɯ ɫɭɝɥɨɛɿɜ ɿ ɩɨɜ'ɹɡɚɧɢɯ ɞɢɫɮɭɧɤɰɿɣ ɦ’ɹɤɢɯ ɬɤɚɧɢɧ,
ɚ ɬɚɤɨɠ ɦɚɧɭɚɥɶɧɿ ɬɪɚɤɰɿʀ (ɦɨɠɥɢɜɿ ɬɚɤɨɠ ɬɪɚɤɰɿʀ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɩɪɢɫɬɪɨʀɜ)
Ⱦɢɯɚɥɶɧɚ ɮɿɡɢɱɧɚ ɬɟɪɚɩɿɹ (ɦɟɬɨɞɢ ɬɚ ɬɟɯɧɿɤɢ ɝɿɝɿɽɧɢ ɞɢɯɚɥɶɧɢɯ ɲɥɹɯɿɜ, ɿɧɝɚɥɹɰɿɣɧɚ ɬɟɪɚɩɿɹ,
ɞɢɯɚɥɶɧɿ ɜɩɪɚɜɢ)
Ɍɟɪɚɩɿɹ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɦɚɫɚɠɭ ɬɚ ɜɿɛɪɚɰɿɣɧɚ ɬɟɪɚɩɿɹ (ɧɚɩɪ. ɜɿɛɪɚɰɿɹ ɜɫɶɨɝɨ ɬɿɥɚ)
ȿɥɟɤɬɪɨɬɟɪɚɩɿɹ (ɧɚɩɪ. ɦɟɬɨɞɢ ɟɥɟɤɬɪɨɫɬɢɦɭɥɹɰɿʀ – ɤɪɿɡɶɲɤɿɪɧɚ ɟɥɟɤɬɪɨɧɟɣɪɨɫɬɢɦɭɥɹɰɿɹ, ɮɭɧɤɰɿɨɧɚɥɶɧɚ
ɟɥɟɤɬɪɨɫɬɢɦɭɥɹɰɿɹ, ɧɟɪɜɨɜɨ-ɦ’ɹɡɨɜɚ ɟɥɟɤɬɪɨɫɬɢɦɭɥɹɰɿɹ, ɫɬɢɦɭɥɹɰɿɹ ɫɩɢɧɧɨɝɨ ɦɨɡɤɭ).
ɇɟɣɪɨɦɨɞɭɥɹɰɿɹ / ɧɟɿɧɜɚɡɢɜɧɿ ɦɟɬɨɞɢ ɫɬɢɦɭɥɹɰɿʀ ɦɨɡɤɭ (ɧɚɩɪ. ɬɪɚɧɫɤɪɚɧɿɚɥɶɧɚ ɫɬɢɦɭɥɹɰɿɹ ɩɨɫɬɿɣɧɢɦ
ɫɬɪɭɦɨɦ, ɩɨɜɬɨɪɸɜɚɥɶɧɚ ɬɪɚɧɫɤɪɚɧɿɚɥɶɧɚ ɦɚɝɧɿɬɧɚ ɫɬɢɦɭɥɹɰɿɹ)
Ɇɚɝɧɿɬɨɬɟɪɚɩɿɹ
Ʌɿɦɮɨɬɟɪɚɩɿɹ (ɧɚɩɪ. ɪɭɱɧɢɣ ɥɿɦɮɚɬɢɱɧɢɣ ɞɪɟɧɚɠ, ɩɟɪɟɜ’ɹɡɭɜɚɧɧɹ)
Ɇɟɞɢɬɚɬɢɜɧɿ ɪɭɯɨɜɿ ɬɟɪɚɩɿʀ (ɧɚɩɪ. ɰɢɝɭɧ, ɣɨɝɚ ɬɚ ɬɚɣ-ɱɢ)
Ɇɚɧɟɜɪɢ (ɧɚɩɪ. ɫɩɟɰɢɮɿɱɧɿ ɪɟɩɨɡɢɰɿɣɧɿ ɦɚɧɟɜɪɢ, ɮɿɡɢɱɧɿ ɤɨɧɬɪ-ɦɚɧɟɜɪɢ ɞɥɹ ɤɨɧɬɪɨɥɸ ɡɚ ɨɪɬɨɫɬɚɬɢɱɧɨɸ
ɝɿɩɨɬɟɧɡɿɽɸ)
ȱɧɲɿ ɦɟɬɨɞɢ ɮɿɡɢɱɧɨʀ ɬɟɪɚɩɿʀ, ɭ ɬɨɦɭ ɱɢɫɥɿ ɭɥɶɬɪɚɡɜɭɤɨɜɚ, ɟɤɫɬɪɚɤɨɪɩɨɪɚɥɶɧɚ ɭɞɚɪɧɨ-ɯɜɢɥɶɨɜɚ ɬɟɪɚɩɿɹ,
ɡɚɫɬɨɫɭɜɚɧɧɹ ɬɟɩɥɚ ɬɚ ɯɨɥɨɞɭ, ɤɨɪɨɬɤɨɯɜɢɥɶɨɜɚ ɞɿɚɬɟɪɦɿɹ, ɬɟɤɚɪɬɟɪɚɩɿɹ, ɨɡɨɧɨɬɟɪɚɩɿɹ ɬɨɳɨ.
Ʉɨɦɩ’ɸɬɟɪɧɿ ɿɝɪɢ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɫɢɫɬɟɦ ɜɿɪɬɭɚɥɶɧɨʀ ɪɟɚɥɶɧɨɫɬɿ / ɿɝɪɨɜɿ ɤɨɧɫɨɥɿ / ɜɿɞɟɨɿɝɪɢ
Ɏɨɬɨɬɟɪɚɩɿɹ (ɧɚɩɪ. ɬɟɪɚɩɿɹ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɭɥɶɬɪɚɮɿɨɥɟɬɨɜɨɝɨ ɜɢɩɪɨɦɿɧɸɜɚɧɧɹ, ɬɟɪɚɩɿɹ ɿɡ ɡɚɫɬɨɫɭɜɚɧɧɹɦ
ɹɪɤɨɝɨ ɫɜɿɬɥɚ, ɥɚɡɟɪɧɚ ɬɟɪɚɩɿɹ)
Ƚɿɞɪɨɬɟɪɚɩɿɹ ɬɚ ɛɚɥɶɧɟɨɬɟɪɚɩɿɹ
Ʉɥɿɦɚɬɨɬɟɪɚɩɿɹ
Ⱥɤɭɩɭɧɤɬɭɪɚ
Ⱥɤɬɢɜɧɨɫɬɿ, ɩɨɜ'ɹɡɚɧɿ ɡ ɞɨɩɨɦɨɝɨɸ ɬɜɚɪɢɧ ɬɚ ɬɟɪɚɩɿɹ ɡ ɞɨɩɨɦɨɝɨɸ ɬɜɚɪɢɧ (ɧɚɩɪ. ɿɩɨɬɟɪɚɩɿɹ, ɜɢɤɨɪɢɫɬɚɧɧɹ
ɫɥɭɠɛɨɜɢɯ ɬɜɚɪɢɧ)
Ƚɿɩɟɪɛɚɪɢɱɧɚ ɨɤɫɢɝɟɧɨɬɟɪɚɩɿɹ

124 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 7 – ÑÔÅÐÀ Ê˲Ͳ×ÍÈÕ ÊÎÌÏÅÒÅÍÒÍÎÑÒÅÉ: ÔÐÌ ÍÀ ÏÐÀÊÒÈÖ²

Ïðîäîâæåííÿ òàáëèö³ IV

ȿɪɝɨɬɟɪɚɩɿɹ
Ɍɟɪɚɩɿɹ ɦɨɜɢ ɬɚ ɦɨɜɥɟɧɧɹ
Ɇɟɧɟɞɠɦɟɧɬ ɞɢɫɮɚɝɿʀ
ɇɟɣɪɨɩɫɢɯɨɥɨɝɿɱɧɿ
ɜɬɪɭɱɚɧɧɹ
ɉɫɢɯɨɥɨɝɿɱɧɿ ɜɬɪɭɱɚɧɧɹ
ɬɚ ɤɨɧɫɭɥɶɬɭɜɚɧɧɹ
ɇɭɬɪɿɬɢɜɧɚ ɬɟɪɚɩɿɹ
Ⱦɨɩɨɦɿɠɧɿ ɬɟɯɧɨɥɨɝɿʀ,
ɩɪɨɬɟɡɭɜɚɧɧɹ, ɨɪɬɟɡɭɜɚɧɧɹ,
ɬɟɯɧɿɱɧɿ ɬɚ ɞɨɩɨɦɿɠɧɿ ɡɚɫɨɛɢ ɫɢɫɬɟɦɢ (ɫɢɫɬɟɦɢ ɤɨɦɭɧɿɤɚɰɿʀ, ɧɚɩɪ. ɬɟɥɟɦɨɧɿɬɨɪɢɧɝ ɱɢ ɬɟɥɟɪɟɚɛɿɥɿɬɚɰɿɹ – ɡɝɚɞɚɧɿ ɜɢɳɟ) ɬɚ ɿɧɲɿ
ɉɚɰɿɽɧɬɢ, ɪɨɞɢɧɢ / ɞɨɝɥɹɞɚɱɿ, ɇɚɜɱɚɥɶɧɿ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɩɚɰɿɽɧɬɿɜ, ɜɤɥɸɱɚɸɱɢ ɧɚɜɱɚɧɧɹ ɫɚɦɨɨɪɝɚɧɿɡɚɰɿʀ (ɧɚɩɪ. ɲɤɨɥɚ ɫɩɢɧɢ)
ɧɚɜɱɚɧɧɹ ɩɪɨɮɟɫɿɨɧɚɥɿɜ,
ɜɤɥɸɱɚɸɱɢ ɧɚɜɱɚɧɧɹ
ɫɚɦɨɨɪɝɚɧɿɡɚɰɿʀ
ɎɊɆ / ɪɟɚɛɿɥɿɬɚɰɿɣɧɟ
ɦɟɞɫɟɫɬɪɢɧɫɬɜɨ
Ⱥɧɚɥɿɡ ɿ ɬɪɟɧɭɜɚɧɧɹ ɚɤɬɢɜɧɨɫɬɟɣ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ ɬɚ ɡɚɧɹɬɶ ɿ ɧɚɜɱɚɧɧɹ ɩɚɰɿɽɧɬɚ ɧɚɜɢɱɤɚɦ ɩɨɞɨɥɚɧɧɹ
ɛɚɪ'ɽɪɿɜ ɭ ɜɢɤɨɧɚɧɧɿ ɚɤɬɢɜɧɨɫɬɟɣ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ
Ɍɪɟɧɭɜɚɧɧɹ ɤɨɝɧɿɬɢɜɧɢɯ ɬɚ ɧɚɜɱɚɥɶɧɢɯ ɫɬɪɚɬɟɝɿɣ ɞɥɹ ɨɛɦɢɧɚɧɧɹ ɤɨɝɧɿɬɢɜɧɢɯ ɩɨɪɭɲɟɧɶ
ȼɬɪɭɱɚɧɧɹ ɡ ɦɟɬɨɸ ɩɨɜɟɪɧɟɧɧɹ ɞɨ ɪɨɛɨɬɢ ɿ ɜɬɪɭɱɚɧɧɹ ɡ ɟɪɝɨɧɨɦɿɤɢ ɞɥɹ ɫɩɪɢɹɧɧɹ ɮɭɧɤɰɿɨɧɭɜɚɧɧɸ
Ɋɟɚɛɿɥɿɬɚɰɿɣɧɿ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɤɟɪɭɜɚɧɧɹ ɬɪɚɧɫɩɨɪɬɧɢɦ ɡɚɫɨɛɨɦ (ɧɚɩɪ. ɨɰɿɧɤɚ ɡɚ ɞɨɩɨɦɨɝɨɸ ɫɢɦɭɥɹɬɨɪɚ
ɤɟɪɭɜɚɧɧɹ)
Ɉɪɬɟɡɭɜɚɧɧɹ
ɇɚɥɚɲɬɭɜɚɧɧɹ ɫɟɪɟɞɨɜɢɳɚ ɧɚ ɪɨɛɨɬɿ ɬɚ ɜɞɨɦɚ
ɋɩɪɢɹɧɧɹ ɞɨɫɬɭɩɭ ɞɨ ɿɧɮɨɪɦɚɰɿɣɧɢɯ ɬɟɯɧɨɥɨɝɿɣ ɬɚ ʀɯ ɜɢɤɨɪɢɫɬɚɧɧɹ, ɜɤɥɸɱɚɸɱɢ ɬɟɥɟɪɟɚɛɿɥɿɬɚɰɿɣɧɿ
ɜɬɪɭɱɚɧɧɹ
Ⱦɨɞɚɬɤɨɜɨ ɞɨ ɬɪɚɞɢɰɿɣɧɢɯ ɦɟɬɨɞɿɜ ɬɟɪɚɩɿʀ ɦɨɜɢ ɬɚ ɦɨɜɥɟɧɧɹ, ɡɚɫɬɨɫɭɜɚɧɧɹ ɿɧɧɨɜɚɰɿɣɧɢɯ ɩɿɞɯɨɞɿɜ
ɞɨ ɪɨɡɥɚɞɿɜ ɦɨɜɢ ɬɚ ɦɨɜɥɟɧɧɹ (ɧɚɩɪ. ɡɚɫɬɨɫɭɜɚɧɧɹ ɬɟɯɧɨɥɨɝɿɣ ɬɟɥɟɦɟɞɢɰɢɧɢ)
ȼɬɪɭɱɚɧɧɹ ɞɥɹ ɫɩɪɢɹɧɧɹ ɤɨɜɬɚɧɧɸ ɿ ɚɞɚɩɬɚɰɿɣɧɿ ɡɚɫɨɛɢ (ɧɚɩɪ. ɜɢɤɨɪɢɫɬɚɧɧɹ ɫɩɟɰɢɮɿɱɧɢɯ ɩɨɡ,
ɦɚɧɟɜɪɿɜ ɩɪɢ ɤɨɜɬɚɧɧɿ, ɦɨɞɢɮɿɤɚɰɿɹ ɤɨɧɫɢɫɬɟɧɰɿʀ ɿ ɪɨɡɦɿɪɭ ɛɨɥɸɫɭ)
Ʉɨɝɧɿɬɢɜɧɟ ɪɟɬɪɟɧɭɜɚɧɧɹ, ɤɨɝɧɿɬɢɜɧɚ ɫɬɢɦɭɥɹɰɿɹ ɬɚ ɤɨɦɩ'ɸɬɟɪɧɿ ɿɧɬɟɪɜɟɧɰɿʀ ɜ ɤɨɧɬɟɤɫɬɿ ɤɨɝɧɿɬɢɜɧɨʀ
ɪɟɚɛɿɥɿɬɚɰɿʀ
Ʉɨɝɧɿɬɢɜɧɿ ɚɛɨ ɩɨɜɟɞɿɧɤɨɜɿ ɬɟɯɧɿɤɢ (ɧɚɩɪ. ɤɨɝɧɿɬɢɜɧɨ-ɩɨɜɟɞɿɧɤɨɜɚ ɬɟɪɚɩɿɹ, ɫɬɪɚɬɟɝɿʀ ɪɟɥɚɤɫɚɰɿʀ, ɦɚɣɧɞɮɭɥɧɟɫ
ɬɟɪɚɩɿɹ, ɦɟɞɢɬɚɰɿɹ, ɛɿɨɥɨɝɿɱɧɢɣ ɡɜɨɪɨɬɧɿɣ ɡɜ'ɹɡɨɤ, ɞɡɟɪɤɚɥɶɧɚ ɬɟɪɚɩɿɹ, ɤɟɪɨɜɚɧɿ ɨɛɪɚɡɢ)
Ⱦɿɽɬɢɱɧɿ ɜɬɪɭɱɚɧɧɹ, ɜɤɥɸɱɚɸɱɢ ɩɨɪɚɞɢ ɬɚ ɤɨɧɫɭɥɶɬɭɜɚɧɧɹ ɡ ɩɢɬɚɧɶ ɯɚɪɱɭɜɚɧɧɹ
Ⱦɨɩɨɦɿɠɧɿ ɬɟɯɧɨɥɨɝɿʀ (Ⱦɨɞɚɬɨɤ 5), ɩɨɱɢɧɚɸɱɢ ɜɿɞ ɧɢɡɤɨɬɟɯɧɨɥɨɝɿɱɧɢɯ ɡɚɫɨɛɿɜ, ɬɚɤɢɯ ɹɤ ɬɪɨɫɬɢɧɢ
ɞɨ ɜɢɫɨɤɨɬɟɯɧɨɥɨɝɿɱɧɨɝɨ ɨɛɥɚɞɧɚɧɧɹ, ɚɛɨ ɫɢɫɬɟɦ, ɬɚɤɢɯ, ɹɤ ɦɨɬɨɪɢɡɨɜɚɧɿ ɜɿɡɤɢ ɚɛɨ ɤɨɦɩ'ɸɬɟɪɢɡɨɜɚɧɿ
ɜ ɩɪɚɤɬɢɰɿ ɪɟɚɛɿɥɿɬɚɰɿʀ, ɜɤɥɸɱɚɸɱɢ ɪɨɛɨɬɢɡɨɜɚɧɿ ɜɬɪɭɱɚɧɧɹ (ɪɨɛɨɬɢɡɨɜɚɧɚ ɪɟɚɛɿɥɿɬɚɰɿɹ)
ɇɚɜɱɚɥɶɧɿ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɪɨɞɢɧ / ɞɨɝɥɹɞɚɱɿɜ (ɧɚɩɪ. ɜɬɪɭɱɚɧɧɹ, ɨɪɿɽɧɬɨɜɚɧɿ ɧɚ ɪɨɞɢɧɭ)
ɇɚɜɱɚɥɶɧɿ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɩɪɨɮɟɫɿɨɧɚɥɿɜ (ɧɚɩɪ. ɬɪɟɧɿɧɝɢ ɡ ɞɨɤɚɡɨɜɨʀ ɦɟɞɢɰɢɧɢ, ɬɪɟɧɿɧɝɢ ɡ ɞɨɫɥɿɞɠɟɧɶ, ȻɆɈ / ȻɉɊ)
Ⱦɨɝɥɹɞ, ɧɚɜɱɚɧɧɹ ɬɚ ɞɨɩɨɦɨɝɚ ɡ ɩɢɬɚɧɶ ɛɟɡɩɟɤɢ (ɧɚɩɪ. ɡɚɩɨɛɿɝɚɧɧɹ ɩɚɞɿɧɧɸ ɜ ɥɿɤɚɪɧɹɯ), ɤɨɧɬɪɨɥɶ ɡɚ ɲɤɿɪɨɸ,
ɫɟɱɨɜɢɦ ɦɿɯɭɪɨɦ ɬɚ ɤɢɲɤɿɜɧɢɤɨɦ, ɯɚɪɱɭɜɚɧɧɹ, ɫɨɧ
Ʉɟɣɫ-ɦɟɧɟɞɠɦɟɧɬ ɲɥɹɯɨɦ ɤɨɦɭɧɿɤɚɰɿʀ ɦɿɠ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨɸ ɤɨɦɚɧɞɨɸ, ɩɚɰɿɽɧɬɨɦ ɬɚ ɪɨɞɢɧɨɸ
ɋɩɪɢɹɧɧɹ ɜɢɩɢɫɰɿ / ɩɟɪɟɫɭɜɚɧɧɸ ɦɿɠ ɡɚɤɥɚɞɚɦɢ

Ñòàíäàðòèçîâàí³ ïðîãðàìè ô³çè÷íî¿ ïî÷àòêîâîãî, ïåð³îäó ñïîñòåðåæåííÿ òà çàê-

òà ðåàá³ë³òàö³éíî¿ ìåäèöèí³
ßê çãàäóâàëîñÿ âèùå, ë³êàð³ ô³çè÷íî¿ òà ðåàá³-
ë³òàö³éíî¿ ìåäèöèíè â³ä³ãðàþòü êîìïëåêñíó ðîëü ó
ïðîãðàìàõ ðåàá³ë³òàö³¿, ùî ïîâ’ÿçàíà ç³ çäîðîâ’ÿì.
Âîíè ïî÷èíàþòüñÿ ç ÷³òêîãî ìåäè÷íîãî ä³àãíîçó,
ôóíêö³îíàëüíîãî òà ñîö³àëüíîãî îö³íþâàííÿ òà ïðî-
äîâæóþòüñÿ ç âèçíà÷åííÿì ð³çíèõ ö³ëåé, ÿê³ íåîá-
õ³äíî äîñÿãòè â³äïîâ³äíî äî ïîòðåá ïàö³ºíòà, ñòâî-
ðåííÿì êîìïëåêñíî¿ ñòðàòå㳿, äîñÿãíåííÿ
³íäèâ³äóàëüíîñò³ âòðó÷àííÿ òà íàãëÿäîì çà êîìàí-
äîþ àáî ìåðåæåâîþ ñï³âïðàöåþ. Âîíà çàê³í÷óºòü-
ñÿ ï³ñëÿ îñòàòî÷íîãî îö³íþâàííÿ óñüîãî ïðîöåñó.
Òàêèé ïðîöåñ ìîæíà íàçâàòè «ïðîãðàìîþ äîïîìî-
ãè ç ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè».
Êîì³òåò êë³í³÷íèõ ñòîñóíê³â Ñåêö³¿ ÔÐÌ ªÑÌÑ
ðîçðîáèâ ñòàíäàðòè àêðåäèòàö³¿ òàêèõ ïðîãðàì òà
îïóáë³êóâàâ ñåð³þ âæå àêðåäèòîâàíèõ (òàáëèöÿ V).
Òàêà àêðåäèòàö³ÿ áàçóºòüñÿ íà íàñòóïíîìó (Äîäà-
òîê 5):
– åï³äåì³îëîã³÷í³ ïîòðåáè òà íàóêîâ³ äîêàçè, ùî
ï³äòðèìóþòü ïðîåêò ïðîãðàìè;
– ö³ëüîâà ïîïóëÿö³ÿ ç êðèòåð³ÿìè âêëþ÷åííÿ òà
âèêëþ÷åííÿ;
– çàãàëüí³ ö³ë³, ñôîðìóëüîâàí³ â³äïîâ³äíî äî ÌÊÔ;
– äîáðå ñòðóêòóðîâàíèé çì³ñò ç äåòàëÿìè ùîäî
ïîðÿäêó äåííîãî ç ìîæëèâèìè ñòàä³ÿìè, ³íñò-
ðóìåíòàìè ä³àãíîñòèêè òà îö³íþâàííÿ (äëÿ
ëþ÷íîãî ïåð³îä³â), çàïëàíîâàíèìè âòðó÷àííÿìè
(áåçïîñåðåäíº ë³êóâàííÿ, îñâ³òà òà íàâ÷àííÿ, ðå-
àá³ë³òàö³ÿ) òà ÷³òêîþ ðîëëþ êîæíîãî ó÷àñíèêà
ïðîãðàìè;
– àäàïòîâàíå îáëàäíàííÿ òà êàäðîâèé ñêëàä, ç
â³äïîâ³äíèì êåð³âíèöòâîì êîìàíäè. ²íñòðóìåí-
òè îö³íþâàííÿ ïîâèíí³ äîïîìîãòè ïðèéíÿòòþ
³íäèâ³äóàëüíèõ ð³øåíü òà íàäàâàòè îá’ºêòèâí³
äàí³ äëÿ çàãàëüíîãî îö³íþâàííÿ ïðîãðàìè;
– êðèòå𳿠âèïèñêè òà ô³íàëüíèé çâ³ò ç ðåêîìåí-
äàö³ºþ ùîäî äîâãîòðèâàëîãî ñïîñòåðåæåííÿ.
Ïðîãðàìè äîïîìîãè ç ô³çè÷íî¿ òà ðåàá³ë³òàö³é-
íî¿ ìåäèöèíè º ãàðíîþ îñíîâîþ äëÿ ÿê³ñíîãî ï³ä-
õîäó. Âèçíà÷åííÿ ïðîãðàì äîïîìîãè ïðèçâîäèòü äî
ï³äêðåñëåííÿ âàæëèâèõ àñïåêò³â ä³ÿëüíîñò³ ÔÐÌ,
à òàêîæ âèñóâຠäåÿê³ ìîìåíòè, ÿê³ ìîæóòü áóòè
ïîêðàùåí³ çà äîïîìîãîþ ïîäàëüøîãî ïëàíó ä³é.
Ñòðóêòóðîâàíå îö³íþâàííÿ áóäå íàäàâàòè ö³êàâ³ äàí³
ïðî ðåçóëüòàòè â óìîâàõ ðåàëüíîãî æèòòÿ.
Ïðîãðàìè äîïîìîãè ç ô³çè÷íî¿ òà ðåàá³ë³òàö³é-
íî¿ ìåäèöèíè ìîæóòü àäàïòóâàòè çàãàëüí³ ïðèíöè-
ïè äî áóäü-ÿêî¿ ì³ñöåâî¿ ïîòðåáè òà ñòàíó. Íà-
ïðèêëàä, ðàííº âòðó÷àííÿ ÔÐÌ ó ë³êàðí³, ùî íàäàº
ãîñòðó äîïîìîãó, ñòâîðèòü ³íøó ïðîãðàìó äëÿ
ëþäåé ç ÷åðåïíî-ìîçêîâèìè òðàâìàìè, í³æ çàêëàä
â ãðîìàä³, ùî íàäຠðåàá³ë³òàö³éí³ ïîñëóãè äëÿ ïî-
ñòðàæäàëèõ â³ä ÷åðåïíî-ìîçêîâèõ òðàâì. À áëîê,
ùî çàéìàºòüñÿ àíàë³çîì ïîñòàâè òà ðóõó çàïðîïî-

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 125
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Òàáëèöÿ V. – Ïðîãðàìè ÔÐÌ, àêðåäèòîâàí³ â Êîì³òåòîì êë³í³÷íèõ ñòîñóíê³â Ñåêö³¿ ÔÐÌ ªÑÌÑ (ç: www.euro-prm.org/
index.php?option=com_content&view=article&id=33&Itemid=187&lang=en)

Ⱥɤɪɟɞɢɬɨɜɚɧɿ ɩɪɨɝɪɚɦɢ
N012 – ɉɪɨɝɪɚɦɚ ɎɊɆ ɞɥɹ ɩɚɰɿɽɧɬɿɜ ɡ ɬɪɚɜɦɚɦɢ ɫɩɢɧɧɨɝɨ ɦɨɡɤɭ ɜ ɩɿɞɝɨɫɬɪɿɣ ɮɚɡɿ – Anda Nulle (Ʌɚɬɜɿɹ)
N011 – ɉɪɨɝɪɚɦɚ ɎɊɆ ɞɥɹ ɩɚɰɿɽɧɬɿɜ ɡ ɩɿɞɜɢɳɟɧɢɦ ɪɢɡɢɤɨɦ ɩɚɞɿɧɧɹ – Andreas Dinsenbacher (Ʌɸɤɫɟɦɛɭɪɝ)
N010 – ɉɪɨɝɪɚɦɚ ɎɊɆ ɞɥɹ ɬɪɚɜɦ ɩɟɪɢɮɟɪɢɱɧɢɯ ɧɟɪɜɿɜ – Primoz Novak (ɋɥɨɜɟɧɿɹ)
N009 – ɉɪɨɝɪɚɦɚ ɎɊɆ ɞɥɹ ɩɚɰɿɽɧɬɿɜ ɡ ɱɟɪɟɩɧɨ-ɦɨɡɤɨɜɨɸ ɬɪɚɜɦɨɸ – Klemen Grabljevec (ɋɥɨɜɟɧɿɹ)
N008 – Myotel: Ɍɟɥɟɥɿɤɭɜɚɧɧɹ ɛɨɥɸ ɜ ɲɢʀ ɬɚ ɩɥɟɱɿ, ɳɨ ʉɪɭɧɬɭɽɬɶɫɹ ɧɚ ɡɜɨɪɨɬɧɨɦɭ ɡɜ'ɹɡɤɭ –ɦɿɨɪɟɥɚɤɫɚɰɿʀ –
Daniel Wever (ɇɿɞɟɪɥɚɧɞɢ)
N007 – Ɇɭɥɶɬɢ-ɩɪɨɮɟɫɿɣɧɢɣ ɦɟɧɟɞɠɦɟɧɬ ɞɿɚɛɟɬɢɱɧɨʀ ɫɬɨɩɢ – Martinus Terburg (ɇɿɞɟɪɥɚɧɞɢ)
N006 – SAMSAH TC-CL 13: ɉɪɨɝɪɚɦɚ ɎɊɆ ɞɥɹ ɞɨɜɝɨɬɪɢɜɚɥɨɝɨ ɫɭɩɪɨɜɨɞɭ ɩɚɰɿɽɧɬɿɜ
ɡ ɱɟɪɟɩɧɨ-ɦɨɡɤɨɜɢɦɢ ɬɪɚɜɦɚɦɢ – Alain Delarque (Ɏɪɚɧɰɿɹ)
N005 – ɉɪɨɝɪɚɦɚ ɎɊɆ ɞɥɹ ɭɪɚɠɟɧɶ ɬɚ ɬɪɚɜɦ ɫɩɢɧɧɨɝɨ ɦɨɡɤɭ – Rajmond Šavrin (ɋɥɨɜɟɧɿɹ)
N004 – ɉɪɨɝɪɚɦɚ ɎɊɆ ɞɥɹ ɩɚɰɿɽɧɬɿɜ ɡ ɫɩɢɧɧɨɦɨɡɤɨɜɨɸ ɬɪɚɜɦɨɸ – Sasa Moslovac (ɏɨɪɜɚɬɿɹ)
N003 – ɉɪɨɝɪɚɦɚ ɞɨɩɨɦɨɝɢ ɡ ɎɊɆ ɞɥɹ ɩɚɰɿɽɧɬɿɜ ɡ ɩɨɩɟɪɟɤɨɜɢɦ ɛɨɥɟɦ ɬɚ ɩɨɩɟɪɟɤɨɜɨ-ɤɪɢɠɨɜɿɣ ɪɚɞɢɤɭɥɨɩɚɬɿʀ –
Svetlana Lenickiene (Ʌɢɬɜɚ)
N002 – ɉɪɨɝɪɚɦɚ ɎɊɆ ɩɿɫɥɹ ɚɪɬɪɨɩɥɚɫɬɢɤɢ ɤɭɥɶɲɨɜɨɝɨ ɬɚ ɤɨɥɿɧɧɨɝɨ ɫɭɝɥɨɛɿɜ – Ieva Michailoviene (Ʌɢɬɜɚ)
N001 – ɎɊɆ ɫɭɩɪɨɜɿɞ ɩɿɫɥɹ ɪɟɤɨɧɫɬɪɭɤɰɿʀ ɩɟɪɟɞɧɶɨʀ ɯɪɟɫɬɨɩɨɞɿɛɧɨʀ ɡɜ’ɹɡɤɢ – Georges de Korvin (Ɏɪɚɧɰɿɹ)
ɉɪɨɝɪɚɦɢ ɡ ɜɢɩɪɨɛɭɜɚɥɶɧɨʀ ɮɚɡɢ
P2 (2008) – ɉɿɫɥɹɬɪɚɜɦɚɬɢɱɧɚ ɝɟɪɿɚɬɪɢɱɧɚ ɪɟɚɛɿɥɿɬɚɰɿɹ. M. Quittan (Ⱥɜɫɬɪɿɹ)
P3 (2008) – Ɋɟɚɛɿɥɿɬɚɰɿɹ ɨɧɤɨɥɨɝɿɱɧɢɯ ɯɜɨɪɢɯ. V. Fialka-Moser (Ⱥɜɫɬɪɿɹ)
P4 (2008) – Ɂɚɝɚɥɶɧɚ ɮɿɡɢɱɧɚ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɚ ɦɟɞɢɰɢɧɚ. G. de Korvin (Ɏɪɚɧɰɿɹ)
P5 (2008) – ɎɊɆ ɬɚ ɩɚɰɿɽɧɬɢ ɡ ɿɧɫɭɥɶɬɨɦ. Nika Goljar (ɋɥɨɜɟɧɿɹ)
P8 (2008) – ɎɊɆ ɬɚ ɩɚɰɿɽɧɬɢ ɡ ɧɟɜɪɨɥɨɝɿɱɧɢɦɢ ɪɨɡɥɚɞɚɦɢ. Zoltan Denes (ɍɝɨɪɳɢɧɚ)
P9 (2008) – ɎɊɆ ɬɚ ɩɚɰɿɽɧɬɢ ɡ ɧɟɜɪɨɥɨɝɿɱɧɢɦɢ ɪɨɡɥɚɞɚɦɢ. A. Giustini (ȱɬɚɥɿɹ)
P17 (2008) – Ɉɰɿɧɸɜɚɧɧɹ ɬɚ ɥɿɤɭɜɚɧɧɹ ɩɚɰɿɽɧɬɿɜ ɡ ɪɨɡɥɚɞɚɦɢ ɯɨɞɶɛɢ ɭ ɞɟɧɧɨɦɭ ɫɬɚɰɿɨɧɚɪɿ ɜ ɝɨɫɬɪɢɯ ɡɚɤɥɚɞɚɯ.
A. Delarque (Ɏɪɚɧɰɿɹ)
P18 (2008) – ɎɊɆ ɬɚ ɩɚɰɿɽɧɬɢ ɡ ɫɩɢɧɧɨɦɨɡɤɨɜɢɦɢ ɬɪɚɜɦɚɦɢ. Jurate KESIENE (Ʌɢɬɜɚ)
P19 (2008) – Ɋɟɚɛɿɥɿɬɚɰɿɹ ɥɸɞɟɣ ɩɿɫɥɹ ɚɦɩɭɬɚɰɿʀ. Metka Presern-Strukelj (ɋɥɨɜɟɧɿɹ)
P21 (2008) – ɋɬɚɰɿɨɧɚɪɧɚ ɩɪɨɝɪɚɦɚ ɪɟɚɛɿɥɿɬɚɰɿʀ ɞɿɬɟɣ. Hermina Damjan (ɋɥɨɜɟɧɿɹ)
P22 (2008) – ɎɊɆ ɬɚ ɩɚɰɿɽɧɬɢ ɡ ɿɧɫɭɥɶɬɨɦ. Tomas Sinocevicius (Ʌɢɬɜɚ)
P24 (2008) – ɎɊɆ ɬɚ ɩɚɰɿɽɧɬɢ ɡ ɨɫɬɨɪɨɩɨɡɨɦ. Katalin Bors (ɍɝɨɪɳɢɧɚ)
P26 (2008) – ɉɪɨɝɪɚɦɚ ɎɊɆ ɞɥɹ ɞɨɪɨɫɥɢɯ ɡ ɧɟɜɪɨɥɨɝɿɱɧɢɦɢ ɪɨɡɥɚɞɚɦɢ. Erzsebet Boros (ɍɝɨɪɳɢɧɚ)

íóº òðåò³é âàð³àíò äîäàòêîâîãî îö³íþâàííÿ òà ïðî-
ãðàìè êîíñóëüòóâàííÿ. Ó äåÿêèõ âèïàäêàõ ïðîãðà-
ìè ÔÐÌ ìîæóòü áóòè íàö³ëåí³ íà äóæå ñïåöèô³÷í³
ïîïóëÿö³¿, çà ñêåðóâàííÿì ³íøèõ ôàõ³âö³â. Íàâïà-
êè, âàì ìîæå çíàäîáèòèñÿ çàäîâîëüíèòè ð³çí³ ïî-
òðåáè ç âèêîðèñòàííÿì ìåíøî¿ ê³ëüêîñò³ òåõíî-
ëîã³é, àëå ç á³ëüøèì îñîáèñòèì ñï³ëêóâàííÿì.
Òîìó áóäü-ÿêó ïðîãðàìó âàðòî ðîçãëÿäàòè ç îä-
íàêîâîþ óâàãîþ.
Ïðîãðàìè äîïîìîãè ïîâèíí³ áóòè íàö³ëåí³ íà
âèð³øåííÿ îäí³º¿ êîíêðåòíî¿ ïðîáëåìè, à íå îïèñó-
âàòè çàãàëüíó ä³ÿëüí³ñòü â³ää³ëåííÿ ÔÐÌ. Íàïðèê-
ëàä, ôîêóñ ìîæå áóòè çðîáëåíèé íà «³íñóëüòí³é
ïðîãðàì³», à íå íà ðîçìîâ³ ïðî «íåâðîëîã³÷í³ ñòàíè»
â ö³ëîìó. Ãîëîâíèì âõîäîì äî ïðîãðàìè ìîæå áóòè:
– ïîðóøåííÿ (ÿê íàñë³äîê ñòàíó çäîðîâ’ÿ): ãåì³-
ïëåã³ÿ, àìïóòàö³ÿ, ñïèííîìîçêîâà òðàâìà, ðå-
êîíñòðóêö³ÿ çâ’ÿçîê êîë³ííîãî ñóãëîáó, ïîïåðå-
êîâèé á³ëü òîùî;
– îáìåæåííÿ àêòèâíîñò³ òà îáìåæåííÿ ìîæëè-
âîñò³ ó÷àñò³: îáìåæåííÿ ïðè õîäüá³, îáìåæåí-
íÿ ñàìîîáñëóãîâóâàííÿ, íåìîæëèâ³ñòü âèêî-
íàííÿ äîìàøí³õ, ðåêðåàö³éíèõ ÷è ñïîðòèâíèõ
àêòèâíîñòåé òà ³íø³;
– ïðîôåñ³éíà ö³ëü àáî ñàìîñò³éíå æèòòÿ äëÿ ëþ-
äåé ï³ñëÿ ÷åðåïíî-ìîçêîâî¿ òðàâìè;
– ïåð³îä æèòòÿ ç ïåâíèìè îñîáëèâîñòÿìè: ä³òè ç
öåðåáðàëüíèì ïàðàë³÷åì, ñïîðòñìåíè ç òðàâìà-
ìè îïîðíî-ðóõîâîãî àïàðàòó, ïðàö³âíèêè ô³çè÷-
íî¿ ïðàö³ ç ïîïåðåêîâèì áîëåì, ë³òí³ ëþäè ç
ðèçèêîì ïàä³ííÿ ³ ³íø³.
ʳëüê³ñòü àêðåäèòîâàíèõ ïðîãðàì ô³çè÷íî¿ òà
ðåàá³ë³òàö³éíî¿ ìåäèöèíè ïîñò³éíî çðîñòàº.
Ùå îäèí ï³äõ³ä äî á³ëüøî¿ ñòàíäàðòèçàö³¿ âòðó-
÷àíü ÔÐÌ â ïðîãðàìàõ ë³êóâàííÿ òà ðåàá³ë³òàö³¿
äëÿ ïåâíèõ ñòàí³â çäîðîâ’ÿ íàäຠÊîì³òåò ïðîôå-
ñ³éíî¿ ïðàêòèêè Ñåêö³¿ ÔÐÌ ªÑÌÑ. ³í äåòàëüíî
îïèñóº Ñôåðó êîìïåòåíòíîñòåé ÔÐÌ ó êîíêðåò-
íèõ ãàëóçÿõ. Ðåçóëüòàòè öèõ çóñèëü îïóáë³êîâàí³
â åëåêòðîíí³é êíèç³ ç³ Ñôåðè êîìïåòåíòíîñòåé
ÔÐÌ, ÿêà äîñòóïíà íà âåá-ñàéò³ Ñåêö³¿ òà Ðàäè
ÔÐÌ ªÑÌÑ 37.
Óïðàâë³íñüê³ íàâè÷êè òà êîíñóëüòàòèâíà
ðîëü ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
˳êàð³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
ìàþòü øèðîêèé ñïåêòð óïðàâë³íñüêèõ íàâè÷îê. Äî
íèõ â³äíîñÿòüñÿ:
– íà ì³êðî-ð³âí³ íàäàííÿ äîïîìîãè: ìåíåäæìåíò
ïàö³ºíòà-êåéñó òà éîãî êîìïëåêñíîñò³, çîêðåìà,
ï³äòðèìêà ïàö³ºíòà/ê볺íòà ùîäî âèáîðó ïðà-
âèëüíèõ ïîñëóã, îòðèìàííÿ ñîö³àëüíî¿ òà þðè-

126 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 7 – ÑÔÅÐÀ Ê˲Ͳ×ÍÈÕ ÊÎÌÏÅÒÅÍÒÍÎÑÒÅÉ: ÔÐÌ ÍÀ ÏÐÀÊÒÈÖ²
äè÷íî¿ ï³äòðèìêè, àäàïòàö³¿ ñåðåäîâèùà òîùî.
Öå òàêîæ âêëþ÷ຠóïðàâë³ííÿ ìóëüòè-ïðîôåñ³é-
íîþ ðåàá³ë³òàö³éíîþ êîìàíäîþ, íàïð. â îðãàí³-
çàö³¿ çóñòð³÷åé, äîêóìåíòóâàíí³ ðåçóëüòàò³â, ñïî-
ñòåðåæåíí³ çà õîäîì âèêîíàííÿ ð³øåíü;
– íà ìåçî-ð³âí³ îðãàí³çàö³¿ ïîñëóãè: óïðàâë³ííÿ
ðåàá³ë³òàö³éíîþ ë³êàðíåþ àáî ³íøîþ ñëóæáîþ,
êåð³âíèöòâî ï³äðîçä³ëîì ÔÐÌ ó âåëèêîìó çàê-
ëàä³. Öå òàêîæ âêëþ÷ຠâïðîâàäæåííÿ òà êîí-
òðîëü âèêîíàííÿ ïðîãðàì óïðàâë³ííÿ ÿê³ñòþ.
Àñïåêòè êâàë³ô³êàö³¿ ÷ëåí³â êîìàíäè, çàáåçïå-
÷åííÿ â³äïîâ³äíèì òåõí³÷íèì îáëàäíàííÿì òà
ô³íàíñîâèìè ðåñóðñàìè º òàêîæ ÷àñòèíîþ ö³º¿
ñôåðè ðîáîòè;
– íà ìàêðî-ð³âí³ ñèñòåì ³ ïîë³òèê â îõîðîíè çäî-
ðîâ’ÿ: âïëèâàòè íà ïîë³òèêó îõîðîíè çäîðîâ’ÿ òà
äèçàéí ñåðåäîâèùà äëÿ ñïðèÿííÿ ó÷àñò³ îñ³á ç
îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà ñòàíàìè, ùî
ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³, âêëþ-
÷àþ÷è äîñòóï äî ðåàá³ë³òàö³éíèõ ïîñëóã. Óïðàâ-
ë³ííÿ ö³ºþ ÷àñòèíîþ ñåðåäîâèùà º âàæëèâèì
ôàêòîðîì óñï³øíî¿ ðåàá³ë³òàö³¿. Ó á³ëüøîñò³ âè-
ïàäê³â öå íå áóäå ðîáèòè îäèí ïðàêòèêóþ÷èé
ë³êàð ÔÐÌ, àëå öå áóäå çä³éñíþâàòèñÿ â êîí-
òåêñò³ òîâàðèñòâ ÔÐÌ àáî â³äïîâ³äàëüíèõ êîì³-
òåò³â òà ³íøèõ çàö³êàâëåíèõ îðãàí³â;
Äëÿ äîñÿãíåííÿ öèõ çàâäàíü íàâ÷àííÿ ç ÔÐÌ
âêëþ÷ຠáàãàòî àñïåêò³â óïðàâë³íñüêèõ íàâè÷îê:
êîìàíäíà ðîáîòà, íàâè÷êè ïëàíóâàííÿ, çíàííÿ ñè-
ñòåì îõîðîíè çäîðîâ’ÿ, óïðàâë³ííÿ ïðîöåñàìè,
ïðèíöèïè íàäàííÿ ïîñëóã, âêëþ÷àþ÷è ô³íàíñîâ³
àñïåêòè, îñíîâè ïîë³òèêè îõîðîíè çäîðîâ’ÿ òîùî.
Ìóëüòè-ïðîôåñ³éíà ñï³âïðàöÿ òà ñï³ëüíà
ðîáîòà êîìàíäè
Ó ë³òåðàòóð³, ùî ñòîñóºòüñÿ êîìàíäíî¿ ðîáîòè
òà ñï³âïðàö³ ó ðåàá³ë³òàö³¿, òåðì³íè ³íîä³ âèêîðèñ-
òîâóþòüñÿ ³íàêøå, í³æ ¿õ âèçíà÷åííÿ â íàóêîâ³é
ë³òåðàòóð³ ç êîìàíäíèõ ìîäåëåé òà âçàºìî䳿 ì³æ
÷ëåíàìè êîìàíäè. Òîìó òóò ïîòð³áíî ïîÿñíåííÿ
òåðì³í³â.
Ó ë³òåðàòóð³ ç ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäè-
öèíè òåðì³íè ïåðåâàæíî âèêîðèñòîâóþòüñÿ äëÿ
îïèñó ïàðòíåð³â ïî ñï³âïðàö³, ÿê³ ïðàöþþòü ðàçîì
â êîìàíä³:
– ìóëüòè-ïðîôåñ³éíà êîìàíäà: êîìàíäà, ùî ñêëà-
äàºòüñÿ ç áàãàòüîõ ôàõ³âö³â ðåàá³ë³òàö³¿ (íàïð.
ë³êàð ÔÐÌ, ô³çè÷íèé òåðàïåâò, åðãîòåðàïåâò,
òåðàïåâò ìîâè òà ìîâëåííÿ, ìåäè÷í³ ñåñòðè òà/
àáî ³íø³);
– ì³æ-äèñöèïë³íàðíà ñï³âïðàöÿ: ñï³âïðàöÿ ì³æ
ð³çíèìè ìåäè÷íèìè ñïåö³àëüíîñòÿìè (íàïð.
ë³êàð ÔÐÌ, òðàâìàòîëîã, íåâðîëîã, êàðä³îëîã òà/
àáî ³íø³)
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ó òåî𳿠êîìàíä òåðì³íè âèêîðèñòîâóþòüñÿ äëÿ
îïèñó øëÿõó ñï³âïðàö³ òà âçàºìî䳿 ì³æ ÷ëåíàìè
êîìàíäè íåçàëåæíî â³ä ¿õ ïðîôåñ³éíî¿ ï³äãîòîâêè:
– ìóëüòè-äèñöèïë³íàðíà êîìàíäíà ðîáîòà: êî-
ìàíäíà ðîáîòà áåç ñèñòåìàòèçîâàíî¿ ñòðóêòó-
ðè òà áåç îðãàí³çîâàíîãî ïðîöåñó ïðèéíÿòòÿ
ð³øåíü. Òàê³ êîìàíäè, ïåðåâàæíî çàñíîâàí³ íà
³ºðàðõ³¿, íå ìàþòü ðåãóëÿðíèõ çáîð³â, îáãîâîðþ-
þòü ëèøå ÷àñòèíè ðîáîòè (àáî êîíêðåòíèõ
ïàö³ºíò³â), ìàþòü ìåíøå ìîæëèâîñòåé äëÿ îá-
ãîâîðåííÿ òà, â áàãàòüîõ âèïàäêàõ, ñï³ëêóþòü-
ñÿ íà äâîñòîðîíí³é îñíîâ³.
– ì³æ-äèñöèïë³íàðíà êîìàíäíà ðîáîòà: ñï³âïðàöÿ
÷ëåí³â êîìàíäè ç ð³çíîþ ï³äãîòîâêîþ, ÿê³ îá’ºä-
íóþòü ñâî¿ çàãàëüí³, ñïåö³àëüí³ çíàííÿ òà äîñâ³ä
äëÿ ñï³ëüíîãî âèð³øåííÿ ïðîáëåì. Òàê³ êîìàíäè
ðåãóëÿðíî çáèðàþòüñÿ, îáãîâîðþþòü óñ³ ïðîáëå-
ìè òà ïðàöþþòü íà îñíîâ³ ð³âíîïðàâíîñò³ âíåñêó
êîæíîãî ÷ëåíà êîìàíäè. гøåííÿ ïðèéìàþòüñÿ
âñ³ºþ êîìàíäîþ (ïåðåâàæíî íà îñíîâ³ êîíñåíñó-
ñó). Ñï³ëêóâàííÿ çàâæäè º áàãàòîñòîðîíí³ì.
Òåðì³í «ìóëüòè-ïðîôåñ³éíà êîìàíäà» áóäå âè-
êîðèñòîâóâàòèñÿ äëÿ ðåàá³ë³òàö³éíî¿ êîìàíäè, ùî
ñêëàäàºòüñÿ ç ð³çíèõ ôàõ³âö³â ðåàá³ë³òàö³¿, ÿê³
ñï³ëüíî ïðàöþþòü ï³ä êåð³âíèöòâîì ë³êàðÿ ÔÐÌ,
òåðì³í «ì³æ-äèñöèïë³íàðíå êîíñóëüòóâàííÿ» áóäå
âèêîðèñòîâóâàòèñÿ äëÿ ñï³âïðàö³ ë³êàð³â ÔÐÌ ç
³íøèìè ìåäè÷íèìè ñïåö³àë³ñòàìè ³ òåðì³í «ñï³ëüíà
ðîáîòà êîìàíäè» áóäå âèêîðèñòîâóâàòèñÿ äëÿ
êîìàíäè, ÿêà ïðàöþº â ì³æ-äèñöèïë³íàðíîìó,
ìóëüòè-äèñöèïë³íàðíîìó àáî òðàíñ-äèñöèïë³íàð-
íîìó ïîðÿäêó â³äïîâ³äíî äî óìîâ ³ ïîòðåá.
ßê çãàäóâàëîñÿ ðàí³øå, òåðàïåâòè÷í³ ö³ë³, îö³-
íþâàííÿ ³ âòðó÷àííÿ â ÔÐÌ º áàãàòîâèì³ðíèìè ³
äóæå ñêëàäíèìè. Òàêèì ÷èíîì, âîíè ïîâèíí³ âè-
êîíóâàòèñÿ íà îñíîâ³ ïðîôåñ³éíèõ çíàíü ³ â³äïîâ³-
äàëüíîñò³, ÿê³ ïîòðåáóþòü çàëó÷åííÿ ³íøèõ
ôàõ³âö³â ó ñôåð³ îõîðîíè çäîðîâ’ÿ, òàêèõ ÿê ô³çè÷í³
òåðàïåâòè, åðãîòåðàïåâòè, ìåäè÷í³ ñåñòðè, òåðà-
ïåâòè ìîâè òà ìîâëåííÿ, îðòåçèñòè, ïðîòåçèñòè òà/
àáî ³íø³ ôàõ³âö³ îõîðîíè çäîðîâ’ÿ. Êîæåí ç íèõ
ðîáèòü âíåñîê â³äïîâ³äíî äî éîãî/¿¿ ñïåöèô³÷íèõ
êîìïåòåíòíîñòåé, îäíàê, ó á³ëüøîñò³ âèïàäê³â
ìåäè÷íà â³äïîâ³äàëüí³ñòü çà ïàö³ºíòà çàëèøàºòü-
ñÿ çà ë³êàðåì ÔÐÌ.
Ôîðìàò ñï³âïðàö³ ìîæå â³äð³çíÿòèñÿ, çàëåæíî â³ä
ôàçè (ãîñòðà, ï³äãîñòðà àáî äîâãîòðèâàëà ðåàá³ë³-
òàö³ÿ) òà çàêëàäó (ë³êàðíÿ, ðåàá³ë³òàö³éíèé öåíòð,
àìáóëàòîðí³ ïîñëóãè ÷è ðåàá³ë³òàö³ÿ, ùî íàäàºòüñÿ
â ãðîìàä³). Ó á³ëüøîñò³ âèïàäê³â ïîòð³áí³ ñòðóêòó-
ðîâàí³ ìóëüòè-ïðîôåñ³éí³ êîìàíäè, ùî ïðàöþþòü
ñï³ëüíî ï³ä êåð³âíèöòâîì ë³êàð³â ÔÐÌ, çàñíîâàí³ íà
çàãàëüíîìó åòè÷íîìó òà íàóêîâîìó ´ðóíò³, à òàêîæ
íà çàãàëüí³é ìåòîäîëî㳿 òà ìîâ³. Öå º îñíîâîþ äëÿ
äîñÿãíåííÿ îïòèìàëüíîãî ð³âíÿ ðåçóëüòàò³â.
127
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Ìóëüòè-ïðîôåñ³éíà êîìàíäíà ðîáîòà ìຠâàæ-
ëèâå çíà÷åííÿ äëÿ ä³àãíîçó òà îö³íþâàííÿ ïîðó-
øåíü, îáìåæåíü àêòèâíîñò³ òà îáìåæåíü ìîæëè-
âîñò³ ó÷àñò³, âèáîðó âàð³àíò³â ë³êóâàííÿ,
êîîðäèíàö³¿ ð³çíîìàí³òíèõ çàõîä³â äëÿ äîñÿãíåííÿ
óçãîäæåíèõ ö³ëåé òà êðèòè÷íî¿ îö³íêè òà ïåðåãëÿ-
äó ïëàí³â/ö³ëåé äëÿ ðåàãóâàííÿ íà çì³íè â çäîðîâ’¿
òà ôóíêö³îíóâàíí³ ïàö³ºíòà (Âñòàâêà 5).
Âñòàâêà 5: Ïðèêëàä ïðèéíÿòòÿ ð³øåíü, îð³ºíòîâàíèõ
íà ïàö³ºíò³â, ó áàãàòîïðîô³ëüí³é êîìàíä³ ðåàá³ë³òàö³¿
Ìàéêë – 48-ð³÷íèé îäðóæåíèé ³íôîðìàòèê, áàòüêî 3 äîíüîê-
ï³äë³òê³â. Ïî äîðîç³ íà ðîáîòó íà ìîòîöèêë³, éîãî çáèâຠâàíòà-
æ³âêà ³ â³í îòðèìóº ïîâíó ïàðàïëåã³þ Ò10. Ïðîãíîç â³äíîâëåí-
íÿ º äóæå îáìåæåíèì, ïðî ùî Ìàéêë áóâ äîñèòü êîðîòêî
ïîâ³äîìëåíèé õ³ðóðãîì. ϳñëÿ 2-òèæíåâîãî ïåðåáóâàííÿ â
ãîñòð³é ë³êàðí³, â³í íàä³éøîâ äî ðåàá³ë³òàö³éíîãî öåíòðó. ×ëåíè
ðåàá³ë³òàö³éíî¿ êîìàíäè (ë³êàð ÔÐÌ, ðåàá³ë³òàö³éíà ìåäñåñòðà,
ô³çè÷íèé òåðàïåâò, åðãîòåðàïåâò, ïñèõîëîã, ñîö³àëüíèé ïðàö³â-
íèê òà ñïîðòèâíèé òåðàïåâò) ï³ä êåð³âíèöòâîì ë³êàðÿ ÔÐÌ ïðî-
âåëè îö³íþâàííÿ òà âñòàíîâèëè êîðîòêîñòðîêîâ³ ö³ë³ íà ïåðø³
òèæí³: âåðòèêàë³çàö³ÿ íà íàõèëåíîìó ñòîë³, ñèä³ííÿ â ìîäóëüíî-
ìó â³çêó, çì³öíåííÿ âåðõí³õ ê³íö³âîê, òðåíóâàííÿ àêòèâíîñòåé
ïîâñÿêäåííîãî æèòòÿ âåðõíüî¿ ÷àñòèíè ò³ëà, êîíòðîëü ôóíêö³é
ñå÷îâîãî ì³õóðà / êèøê³âíèêà ìåäè÷íèìè ñåñòðàìè. Ìàéêë ñèëü-
íî çàñìó÷åíèé, ìàëî ñïèòü ³ ìîòèâàö³ÿ äî âòðó÷àííÿ º íèçüêîþ.
Íà äðóãèõ çáîðàõ êîìàíäè ïñèõîëîã ä³ëèòüñÿ ç êîìàíäîþ, ùî
ïàö³ºíò çíàõîäèòüñÿ â äåïðåñèâíîìó íàñòðî¿, ñêó÷ຠçà ðîäè-
íîþ ³ íå áà÷èòü ñåíñó â ìàéáóòíüîìó. ³í ñòâåðäæóº, ùî æèòòÿ
íå ìຠñåíñó ³ çàäຠïèòàííÿ ùîäî ìîæëèâîñò³ ïðèïèíåííÿ æèò-
òÿ. Íà ïèòàííÿ, «ùî º âàæëèâèì äëÿ âàñ», â³í â³äïîâ³äàº, ùî
äóæå âàæëèâèì º çíàõîäæåííÿ âäîìà ³ ïðèãîòóâàííÿ ¿æ³ äëÿ
ñâ ñ³ì’¿ ïðîòÿãîì âèõ³äíèõ. Ïðèãîòóâàííÿ ¿æ³ – öå éîãî âå-
ëèêà ïðèñòðàñòü òà õîá³. Ç òðüîìà ñòàðèìè øê³ëüíèìè äðóçÿìè
âîíè ìàþòü «êóë³íàðíèé êëóá» îäíó ñóáîòó íà ì³ñÿöü ó ñâî¿õ
áóäèíêàõ, à ââå÷åð³ ¿õ äðóæèíè ïðèºäíóþòüñÿ äî âå÷åð³.
Áóëè øâèäêî çàïëàíîâàí³ íîâ³ çáîðè êîìàíäè ðàçîì ç
Ìàéêëîì òà éîãî äðóæèíîþ, äëÿ âñòàíîâëåííÿ ñï³ëüíèõ ö³ëåé.
Òàì â³í çìîæå âèðàçèòè ñâî¿ â³ä÷óòòÿ òà äîñâ³ä ïåðåáóâàííÿ
ó áëîö³ ñïèííîìîçêîâî¿ òðàâìè. Âñòàíîâëþþòüñÿ íîâ³ ö³ë³ äëÿ
êîðîòêîãî, òà äëÿ äîâãîãî òåðì³í³â. Ó äîâãîñòðîêîâ³é ïåðñ-
ïåêòèâ³ çàïðîïîíîâàíà àäàïòàö³ÿ äîì³âêè, âêëþ÷àþ÷è ³íôðà-
ñòðóêòóðó êóõí³. Ïîâåðíåííÿ äî ðîáîòè çäàºòüñÿ ìîæëèâèì,
çà óìîâè âñòàíîâëåííÿ ó éîãî êîìïàí³¿ òóàëåòó, äîñòóïíîãî
äëÿ â³çêà. Îñê³ëüêè ðîäèíà êàòàºòüñÿ íà ëèæàõ äâ³÷³ íà ð³ê, òî,
ÿê ò³ëüêè áóäå äîçâîëÿòè ñòàí, áóäóòü çàïëàíîâàí³ ïåâí³ ëèæí³
çàíÿòòÿ ó ïðèì³ùåíí³ ç³ ñïîðòèâíèì òåðàïåâòîì, òà ïðè ¿õ óñ-
ï³øíîñò³, äî ïåðåë³êó äîïîì³æíèõ ïðèñòðî¿â äëÿ ñòðàõîâî¿
êîìïàí³¿ âîä³ÿ âàíòàæ³âêè, ÿêèé, ÿê áóëî âèçíà÷åíî, º â³äïî-
â³äàëüíèì çà àâàð³þ, áóäóòü äîäàí³ ñèäÿ÷³ ëèæ³. Îñê³ëüêè
Ìàéêë äóæå õî÷å áðàòè ó÷àñòü ó êóë³íàðíîìó êëóá³ òàêîæ ³
ó éîãî äðóç³â, ç ö³ºþ ìåòîþ áóäå ïðîâîäèòèñü òðåíóâàííÿ
õîäè/ñòîÿííÿ, ñïî÷àòêó ç êðóãîâèìè îðòåçàìè íà íîãàõ, ïîò³ì
ç îðòåçîì íà êîë³íà-ùèêîëîòêó -ñòîïó òà Walkabout. Íà êî-
ðîòêèé òåðì³í ìåäè÷í³ ñåñòðè íàâ÷àòü éîãî ïåðåì³æíî¿ ñàìî-
êàòåòåð³çàö³¿, ô³çè÷í³ òåðàïåâòè çîñåðåäÿòü óâàãó íà òðåíó-
âàíí³ êîðèñòóâàííÿì â³çêîì òà ïåðåì³ùåííÿì, à åðãîòåðàïåâòè
– íà íåçàëåæíîñò³ äëÿ îñîáèñòèõ àêòèâíîñòåé ïîâñÿêäåííîãî
æèòòÿ. Çà äåê³ëüêà òèæí³â çàïëàíîâàí³ â³çèò äîäîìó ç åðãîòå-
ðàïåâòîì òà ïåðøèé âèõ³äíèé âäîìà, ï³ñëÿ ÷îãî – äðóãèé êðóã-
ëèé ñò³ë, ó ÿêîìó òàêîæ â³çüìóòü ó÷àñòü äîíüêè ïîäðóææÿ.
Çàâäÿêè ò³ñí³é ó÷àñò³ Ìàéêëà òà éîãî ðîäèíè ó ïîñòàíîâö³
ö³ëåé, òåðàï³ÿ íàáóâຠçíà÷íî á³ëüøîãî çíà÷åííÿ äëÿ Ìàéê-
ëà, ³ â³í çíàõîäèòü åíåðã³þ äëÿ á³ëüø àêòèâíî¿ ó÷àñò³.
128 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ó áàãàòüîõ âèïàäêàõ ðåàá³ë³òàö³ÿ âèìàãຠì³æ-
äèñöèïë³íàðíîãî êîíñóëüòóâàííÿ ç ³íøèìè ë³êàðÿ-
ìè-ñïåö³àë³ñòàìè, çîêðåìà ï³ñëÿ îïåðàòèâíèõ âòðó-
÷àíü, ïðîòÿãîì ä³àãíîñòè÷íî¿ ôàçè çàõâîðþâàííÿ
òà äëÿ ïëàíóâàííÿ áàãàòîâèì³ðíîãî ë³êóâàëüíîãî
ïëàíó. Ìåäè÷íèì ñïåö³àë³ñòàì íåîáõ³äíî óçãîäè-
òè ñï³ëüíó ñòðàòåã³þ, ÿêà âêëþ÷ຠâñ³ ¿õ âòðó÷àí-
íÿ â ïîòð³áíèé ÷àñ äëÿ äîñÿãíåííÿ çàãàëüíîãî
ï³äõîäó äî çàãàëüíî¿ ñòðàòå㳿 ë³êóâàííÿ. Ðåãóëÿðí³
âíåñêè ìîæóòü âèìàãàòèñü â³ä ³íøèõ ìåäè÷íèõ
ñïåö³àë³ñò³â ÿê â â³ää³ëåííÿõ ãîñòðî¿ ðåàá³ë³òàö³¿,
òàê é â óìîâàõ äîâãîòðèâàëî¿ ðåàá³ë³òàö³¿ (ïåðåâàæ-
íî ó ñï³âïðàö³ ç ë³êàðÿìè ïåðâèííî¿ äîïîìîãè).
Êîìàíäè ÔÐÌ íå ëèøå âêëþ÷àþòü ÷ëåí³â ç
ð³çíîþ ïðîôåñ³éíîþ ï³äãîòîâêîþ, àëå òàêîæ ïðà-
öþþòü íàä óçãîäæåíèìè ö³ëÿìè, âèêîðèñòîâóþ÷è
ñï³ëüí³ ñòðàòå㳿. Öå á³ëüøå, í³æ äîäàâàííÿ ðîáî-
òè ð³çíèõ ôàõ³âö³â îõîðîíè çäîðîâ’ÿ â ðîáîò³ ìóëü-
òè-ïðîôåñ³éíî¿ êîìàíäè (ï³ä êåð³âíèöòâîì ë³êàðÿ
ÔÐÌ) ³ ðîçóì³ííÿ ðîë³ ³ ö³ííîñò³ êîëåã. Êîìàíäà
ïðàöþº, ùîá âñòàíîâèòè ö³ë³, ñêîðèãîâàí³ ç ÷àñîì,
òà â³äïîâ³äíî äî êë³í³÷íîãî òà ôóíêö³îíàëüíîãî
ïðîãðåñó ïàö³ºíòà. Íàéâàæëèâ³øèìè ïðèíöèïàìè
óñï³øíî¿ êîìàíäíî¿ ðîáîòè º38:
– â³äïîâ³äíèé ä³àïàçîí çíàíü òà âì³íü äëÿ óçãîä-
æåíèõ çàâäàíü;
– âçàºìíà äîâ³ðà òà ïîâàãà;
– áàæàííÿ ä³ëèòèñÿ çíàííÿìè òà äîñâ³äîì;
– â³äêðèòå âèñëîâëåííÿ äóìîê.
Êîìàíäà áåçïîñåðåäíüî çàëó÷ຠïàö³ºíòà òà
éîãî/¿¿ çíà÷óùèõ îñ³á/÷ëåí³â ñ³ì’¿ äëÿ âñòàíîâëåí-
íÿ â³äïîâ³äíèõ òà ðåàë³ñòè÷íèõ ö³ëåé âòðó÷àíü â
ìåæàõ çàãàëüíî¿ óçãîäæåíî¿ ïðîãðàìè ðåàá³ë³òàö³¿.
Ö³ ö³ë³ ïîâèíí³ áóòè îð³ºíòîâàíèìè íà ïàö³ºíòà,
ï³äòðèìóâàòèñÿ êîìàíäîþ ³ ïîñò³éíî êîðèãóâàòè-
ñÿ ïðîòÿãîì ðåàë³çàö³¿ ïðîãðàìè ÔÐÌ.
Ñï³âïðàöÿ â ðåàá³ë³òàö³éí³é êîìàíä³ çàáåçïå-
÷óºòüñÿ ñòðóêòóðîâàíîþ êîìóí³êàö³ºþ âñåðåäèí³
êîìàíäè òà ðåãóëÿðíèìè çáîðàìè êîìàíäè ç îá-
ãîâîðåííÿì ä³àãíîçó, ôóíêö³îíàëüíîãî âïëèâó íà
ôóíêö³îíóâàííÿ òà àêòèâí³ñòü ïàö³ºíòà, éîãî ìîæ-
ëèâîñò³ áðàòè ó÷àñòü â æèòò³ ñóñï³ëüñòâà, à òàêîæ
ìîæëèâèõ ðèçèê³â ³ ïðîãíîçó õâîðîáè. Îö³íþâàííÿ
÷ëåí³â êîìàíäè âêëþ÷àþòüñÿ â ïëàí ðåàá³ë³òàö³¿,
ÿêèé ðåãóëÿðíî ïåðåãëÿäàºòüñÿ.
Óñï³øí³ êîìàíäè ïîâèíí³ âêëþ÷àòè øèðîêèé
ñïåêòð çíàíü, çä³áíîñòåé òà ïðîôåñ³éíèõ íàâè÷îê,
à ÷ëåíàìè â ïåðøó ÷åðãó º: ë³êàð³ ÔÐÌ, ìåäè÷í³
ñåñòð³ ç ðåàá³ë³òàö³éíèìè çíàííÿìè, ô³çè÷í³ òåðà-
ïåâòè, åðãîòåðàïåâòè, òåðàïåâòè ìîâè òà ìîâëåí-
íÿ, êë³í³÷í³ ïñèõîëîãè òà íåéðîïñèõîëîãè, ñîö³àëüí³
ïðàö³âíèêè, ïðîòåçèñòè òà îðòåçèñòè, á³î³íæåíåðè,
à òàêîæ íóòð³ö³îí³ñòè39. Ñòðóêòóðà êîìàíä ìîæå
â³äð³çíÿòèñÿ â ð³çíèõ ºâðîïåéñüêèõ êðà¿íàõ ³ çàëå-
æèòü â³ä ñïåöèô³êè êîæíîãî â³ää³ëåííÿ ðåàá³ë³òàö³¿.
¹2(2) *2018
 ÐÎÇÄ²Ë 7 – ÑÔÅÐÀ Ê˲Ͳ×ÍÈÕ ÊÎÌÏÅÒÅÍÒÍÎÑÒÅÉ: ÔÐÌ ÍÀ ÏÐÀÊÒÈÖ²
×ëåíè êîìàíäè ïîâèíí³ ìàòè íàëåæíó êâàë³ô³-
êàö³þ ç ö³ëåñïðÿìîâàíîþ íàóêîâîþ òà ïðîôåñ³é-
íîþ îñâ³òîþ (áàçîâîþ òà áåçïåðåðâíîþ). Ïîòð³áí³
çíàííÿ ³ ïîâàãà äî íàâè÷îê ³ çä³áíîñòåé ³íøèõ ÷ëåí³â
êîìàíäè. ˳êàð³ ÔÐÌ çîáîâ’ÿçàí³ íàäàâàòè àäåê-
âàòíó ³íôîðìàö³þ, íàâ÷àííÿ òà êë³í³÷íó ï³äòðèì-
êó, àëå êîæíèé ôàõ³âåöü îõîðîíè çäîðîâ’ÿ íåñå
îñîáèñòó â³äïîâ³äàëüí³ñòü çà äîòðèìàííÿ ñòàí-
äàðò³â éîãî/¿¿ ïðîôåñ³¿.
Ó ÷ëåí³â êîìàíäè ïîâèíí³ áóòè òàê³ êîìïåòåíò-
íîñò³39:
– ë³êàð³: ä³àãíîñòèêà îñíîâíî¿ ïàòîëî㳿 òà ïîðó-
øåíü, ïðîãíîç, ìåäè÷íå îö³íþâàííÿ òà ë³êóâàí-
íÿ, ñòâîðåííÿ ïëàíó ë³êóâàííÿ òà ðåàá³ë³òàö³¿,
ïðèçíà÷åííÿ ôàðìàêîëîã³÷íèõ òà íå ôàðìàêî-
ëîã³÷íèõ ìåòîä³â ë³êóâàííÿ òà îö³íêà åôåêòó â³ä
íèõ;
– ðåàá³ë³òàö³éí³ ìåäè÷í³ ñåñòðè: çîñåðåäæåííÿ íà
òà ìîí³òîðèíã ïîòðåá ïîâñÿêäåííî¿ äîïîìîãè.
Ñïåö³àëüí³ çíàííÿ â îáëàñò³ ìåíåäæìåíòó æèò-
òºçäàòíîñò³ òêàíèí òà ïðîáëåì òàçîâèõ îðãàí³â.
Íàäàííÿ åìîö³éíî¿ ï³äòðèìêè ïàö³ºíòàì òà ¿õ
ñ³ì’ÿì. Íàâ÷àííÿ ïàö³ºíò³â ³ ÷ëåí³â ¿õ ðîäèí;
– ô³çè÷í³ òåðàïåâòè: äåòàë³çîâàíå îö³íþâàííÿ
ïðîáëåì ïîñòàâè òà ðóõó, ïðèçíà÷åííÿ ô³çè÷íèõ
ìåòîä³â ë³êóâàííÿ, âêëþ÷àþ÷è âïðàâè äëÿ
â³äíîâëåííÿ ðóõ³â òà ïîëåãøåííÿ áîëþ òîùî;
– åðãîòåðàïåâòè: îö³íþâàííÿ âïëèâó ô³çè÷íèõ àáî
êîãí³òèâíèõ ïðîáëåì íà àêòèâíîñò³ ïîâñÿêäåí-
íîãî æèòòÿ, ïîâåðíåííÿ äî ðîáîòè, àêòèâíîñò³
íàâ÷àííÿ òà/àáî äîçâ³ëëÿ. Çàáåçïå÷åííÿ ñïå-
ö³àëüíèìè çíàííÿìè ùîäî ñòðàòåã³é, ÿê³ ìîæóòü
áóòè âèêîðèñòàí³ ïàö³ºíòîì òà éîãî/¿¿ ðîäèíîþ,
âèêîðèñòàííÿ äîïîì³æíèõ òåõíîëîã³é äëÿ àäàï-
òàö³¿ ñåðåäîâèùà äëÿ ñïðèÿííÿ íåçàëåæíîñò³;
– òåðàïåâòè ìîâè òà ìîâëåííÿ: îö³íþâàííÿ òà
òåðàï³ÿ êîãí³òèâíèõ, êîìóí³êàòèâíèõ ïðîáëåì,
ïðîáëåì ìîòîðèêè ðîòà òà îáëè÷÷ÿ òà ðîçëàä³â
êîâòàííÿ;
– êë³í³÷í³ ïñèõîëîãè òà íåéðîïñèõîëîãè: äåòàë³çî-
âàíå îö³íþâàííÿ êîãí³òèâíèõ, ïåðöåïòèâíèõ òà
åìîö³éíèõ / ïîâåä³íêîâèõ ïðîáëåì. Ðîçðîáêà ðà-
çîì ñ ïàö³ºíòîì, éîãî ñ³ì’ºþ òà ³íøèìè ôàõ³â-
öÿìè îõîðîíè çäîðîâ’ÿ ñòðàòåã³é ùîäî ¿õ ìå-
íåäæìåíòó;
– ñîö³àëüí³ ïðàö³âíèêè: ñïðèÿííÿ ó÷àñò³, ðå³íòå-
ãðàö³ÿ ó ñóñï³ëüñòâî òà ñîö³àëüí³é ï³äòðèìö³;
– ïðîòåçèñòè ³ îðòåçèñòè: ñïåö³àëüí³ çíàííÿ â îá-
ëàñò³ çàáåçïå÷åííÿ òåõíîëîã³ÿìè, ïî÷èíàþ÷è
â³ä øèí ³ øòó÷íèõ ê³íö³âîê äî çàñîá³â êîíòðî-
ëþ íàâêîëèøíüîãî ñåðåäîâèùà;
– á³î³íæåíåðè òà ³íæåíåðè ç ðåàá³ë³òàö³¿: ñòîñîâ-
íî òåõíîëîã³é òà çáîðó äàíèõ;
– íóòð³ö³îí³ñòè: îö³íþâàííÿ òà ñïðèÿííÿ àäåêâàò-
íîìó õàð÷óâàííþ.
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ðîëü ë³êàðÿ ÔÐÌ â êîìàíä³ º ñóòòºâîþ äëÿ
âñòàíîâëåííÿ ìåäè÷íîãî ä³àãíîçó, ôóíêö³îíàëüíî¿
îö³íêè, ïðèçíà÷åíü, ïëàíó ë³êóâàííÿ ³ êåð³âíèöòâà
êîìàíäîþ. Âîíà ´ðóíòóºòüñÿ íà ìåäè÷íèõ òà åòè÷-
íèõ ïðèíöèïàõ, ìîäåë³ ÌÊÔ ôóíêö³é òà ñòðóêòóð
îðãàí³çìó, àêòèâíîñò³, ó÷àñò³ òà êîíòåêñòóàëüíèõ
ôàêòîðàõ, à òàêîæ íàóêîâèõ ðåçóëüòàòàõ (äîêàçî-
âà îõîðîíà çäîðîâ’ÿ). Êë³í³÷íå âòðó÷àííÿ ïîâèííî
áóòè íàö³ëåíèì íà ñòàí çäîðîâ’ÿ, ïîðóøåííÿ, îá-
ìåæåííÿ àêòèâíîñò³ ³ îáìåæåííÿ ìîæëèâîñò³
ó÷àñò³. Ïðîòå, ïðàêòè÷íî âñ³ ðåàá³ë³òàö³éí³ âòðó-
÷àííÿ ìàþòü ðèçèêè, ÿê³ ïîòð³áíî ïåðåäáà÷èòè ç
â³äïîâ³äàëüí³ñòþ. Ç ö³º¿ ïðè÷èíè, ïåðåä êîæíèì
ðåàá³ë³òàö³éíèì âòðó÷àííÿì ñóòòºâèì º ðåòåëüíèé
ìåäè÷íèé ä³àãíîç òà îö³íþâàííÿ.
Äëÿ îïòèì³çàö³¿ ïðîãðàì ÔÐÌ ÷ëåíè êîìàíäè
ïîâèíí³ ðîçóì³òè ñâ³é êîíêðåòíèé âíåñîê äî
ñï³ëüíî¿ ðîáîòè êîìàíäè, àëå ë³êàð³ ÔÐÌ íåñóòü
â³äïîâ³äàëüí³ñòü çà çàáåçïå÷åííÿ êîìïëåêñíîãî
îïèñó ìîäåë³ äîïîìîãè äëÿ êîæíî¿ îñîáè, òà î÷î-
ëþþòü ïðîöåñ ïðèéíÿòòÿ ð³øåíü.
Ñï³ëüíà ðîáîòà êîìàíä³ âñòàíîâëþº ì³öí³ â³äíî-
ñèíè ç óñ³ìà çàö³êàâëåíèìè ñòîðîíàìè êîìàíäè
ÔÐÌ, ùî ´ðóíòóþòüñÿ íà â³äêðèòîñò³ ³ âçàºìí³é
ïîâàç³ òà âðàõóâàíí³ òåõí³÷íèõ íàâè÷îê îäèí îäíî-
ãî. Óñï³õ êîìàíäè ïîëÿãຠó âñòàíîâëåíí³ êîìóí³-
êàö³¿, äîêëàäàíí³ çóñèëü äëÿ ïîäîëàííÿ òðóäíîù³â,
ÿêèõ çàçíຠïàö³ºíò.
˳êàð³ ÔÐÌ â³ä³ãðàþòü ñóòòºâó ðîëü â ñï³âïðà-
öþþ÷èõ êîìàíäàõ: î÷îëþþòü, ïðîâîäÿòü ä³àãíî-
ñòèêó, ñòèìóëþþòü îáãîâîðåííÿ, ðîçðîáëÿþòü ³
îö³íþþòü íîâ³ óïðàâë³íñüê³ ñòðàòå㳿 äëÿ êåðóâàí-
íÿ ðåàá³ë³òàö³éíèì ïëàíîì òà çàáåçïå÷åííÿ
êë³í³÷íîãî óñï³õó.
Åòèêà â êë³í³÷í³é ïðàêòèö³ ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
Ôàõ³âö³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
ö³ëåñïðÿìîâàíî çàëó÷àþòü ïàö³ºíò³â, ¿õ ñ³ì’¿ òà
äîãëÿäà÷³â äî ïðîöåñó âñòàíîâëåííÿ ö³ëåé ³ ðîç-
ãëÿäàþòü åòè÷í³ äèëåìè ÿê ÷àñòèíó öüîãî ïðîöå-
ñó. Öå òàêîæ ñòîñóºòüñÿ ð³øåíü ïåð³îäó çàê³í÷åí-
íÿ æèòòÿ, äëÿ ÿêèõ êîæíà êîíêðåòíà êðà¿íà ìຠñâî¿
ïðàâîâ³ ðàìêè. Íàïðèêëàä, ó Áåëü㳿 òà ͳäåðëàí-
äàõ ïàö³ºíòè ç íåñòåðïíèìè ñòðàæäàííÿìè âíàñë³-
äîê âàæêîãî íåâèë³êîâíîãî ñòàíó çäîðîâ’ÿ ìîæóòü
âèáðàòè åâòàíàç³þ, ÿêùî ¿õ ñèòóàö³ÿ â³äïîâ³äàº
âèìîãàì çàêîíó.
˳êàð³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè ðå-
ãóëÿðíî âðàõîâóþòü ïðàâà ñâî¿õ ïàö³ºíò³â ó ñâî¿é
ïîâñÿêäåíí³é ïðàêòèö³, à åòè÷í³ òà ìîðàëüí³ ð³øåí-
íÿ ïðèéìàþòüñÿ ó ñôåð³ ÔÐÌ ùîäåííî. Áàãàòî ç
íèõ º íåçíà÷íèìè, íàïð. ð³øåííÿ ïîÿñíèòè ðèçèêè
³ îòðèìàòè ³íôîðìîâàíó çãîäó íà âíóòð³øíüîñóã-
129
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ëîáîâó ³í’ºêö³þ àáî åëåêòðîä³àãíîñòè÷íó ïðîöåäó-
ðó. ²íø³, îäíàê, º á³ëüø ñêëàäíèìè òà êîìïëåêñ-
íèìè, òà ìîæóòü âèìàãàòè ó÷àñò³ ê³ëüêîõ ð³çíèõ
ëþäåé. Äåÿê³ ïèòàííÿ º äîñèòü ñïåöèô³÷íèìè äëÿ
ñïåö³àëüíîñò³. Áåðó÷è äî óâàãè çãàäàí³ âèùå åòè÷í³
ïðèíöèïè, áóäå ðîçãëÿíóòî åòè÷í³ ïðîáëåìè òðüîõ
âèä³â, ùî ÷àñòî çóñòð³÷àþòüñÿ â ðåàá³ë³òàö³éí³é
ìåäèöèí³: ðîçïîä³ë ðåñóðñ³â òà âèá³ð ïàö³ºíò³â, åòè-
êà êîìàíäíî¿ äîïîìîãè òà åòè÷í³ ïðîáëåìè ïðè
âñòàíîâëåíí³ ö³ëåé. Ìåòîþ º íå îáîâ’ÿçêîâå çàáåç-
ïå÷åííÿ íåïîðóøíèõ â³äïîâ³äåé, à ðîçãëÿä ïèòàí-
íÿ òà ð³çíèõ ìîæëèâîñòåé, ÿê³ ìîæóòü áóòè âèêî-
ðèñòàí³ äëÿ ñïðèÿííÿ ïðîöåñó ïðèéíÿòòÿ ð³øåíü.
Öåé òåêñò íå ìîæå äóæå äîêëàäíî ðîçãëÿäàòè
äàíó ñèòóàö³þ, ïðîòå áóäóòü íàâåäåí³ äâà ïðèêëà-
äè – âèá³ð ïàö³ºíò³â ³ ðîçïîä³ë ðåñóðñ³â. Õòî âèð³-
øóº, ÿêèõ ïàö³ºíò³â ñë³ä ïðèéìàòè äî ðåàá³ë³òàö³é-
íèõ çàêëàä³â, à ÿêèõ í³, ³ ÿê êë³í³öèñòè ñïðàâëÿþòüñÿ
ç íåîáõ³äí³ñòþ ðîçïîä³ëó îáìåæåíèõ ðåñóðñ³â?
Siegert, et al.40 ðîçãëÿíóâ, ÿê ôàõ³âö³ ðåàá³ë³òàö³¿
çàõèùàþòü ïðàâà ³ ã³äí³ñòü ñâî¿õ ïàö³ºíò³â íà òë³
çðîñòàþ÷î¿ ê³ëüêîñò³ ë³òåðàòóðè ç ïðàâ ëþäèíè,
îñîáëèâî ñòîñîâíî çäîðîâ’ÿ òà ðåàá³ë³òàö³¿. Öÿ
ñòàòòÿ áóëà ñïðÿìîâàíà íà òå, ùîá îçíàéîìèòè
ôàõ³âö³â ðåàá³ë³òàö³¿ ç òèì, ÿêå ì³ñöå çàéìàþòü
ïðàâà ëþäèíè â ðåàá³ë³òàö³éí³é ïðàêòèö³, ³ ñòèìó-
ëþâàòè ïîäàëüøó äèñêóñ³þ òà îáãîâîðåííÿ. Ó í³é
áóëî âèñâ³òëåíî äåÿê³ âàæëèâ³ â³õè â íåäàâí³é
³ñòî𳿠ïðàâîçàõèñíîãî ðóõó òà ïîÿñíåíî äåÿê³ âàæ-
ëèâ³ òåðì³íè â ë³òåðàòóð³ ç ïðàâ. ³í îïèñàâ ìîäåëü
ñòðóêòóðè ïðàâ ëþäèíè Ward òà Birgden, ÿê ïðè-
êëàä ïåðñïåêòèâè ïðàâ, ÿêà ìîæå ìàòè îñîáëèâå
çíà÷åííÿ äëÿ çäîðîâ’ÿ ³ ñîö³àëüíèõ ïîñëóã òà ðåà-
á³ë³òàö³¿41.
Çðåøòîþ, ìåòîþ ðåàá³ë³òàö³éíî¿ ìåäèöèíè º
çàáåçïå÷åííÿ ñàìîñò³éíîñò³ ïàö³ºíòà, äîáðî-
ä³éíîñò³ òà çàêîííîñò³, ïðàãíó÷³ íàäàòè ìàêñèìàëü-
íî ìîæëèâó äîïîìîãó, îäíî÷àñíî ïîâàæàþ÷è ïî-
áàæàííÿ ³ ïðèíöèïè ñóñï³ëüñòâà â ö³ëîìó â ðàìêàõ
îáìåæåíü íàÿâíèõ ðåñóðñ³â. ²íø³ ôàêòîðè âêëþ-
÷àþòü âèá³ð ïàö³ºíò³â äëÿ ðåàá³ë³òàö³¿, ä³ÿëüí³ñòü
òà êîìïåòåíòíîñò³ êîìàíäè ÔÐÌ, âñòàíîâëåííÿ
ö³ëåé ó êîíòåêñò³ ÔÐÌ òà ðîçïîä³ë ðåñóðñ³â42.
Íà çàê³í÷åííÿ, â ïðàêòèö³ ðåàá³ë³òàö³¿ ìè âñå
÷àñò³øå ñòèêàºìîñÿ ç äóæå äåë³êàòíèìè åòè÷íè-
ìè ïèòàííÿìè. Ìàêðîð³âåíü ³ñíóº ÿê ñòðóêòóðà, àëå
ð³øåííÿ ïðèéìàþòüñÿ ùîäíÿ íà ì³êðî- òà ìåçî-
ð³âíÿõ. Öÿ åâîëþö³ÿ º íàñë³äêîì íèçêè ³ñòîòíèõ
ìåäè÷íèõ, òåõí³÷íèõ òà ñîö³àëüíèõ åâîëþö³é ïðî-
òÿãîì îñòàíí³õ äåñÿòèë³òü. Åòè÷í³ ö³ííîñò³ òà êóëü-
òóðàëüí³ ïåðåêîíàííÿ ïðîôåñ³îíàë³â, à òàêîæ
ïàö³ºíò³â, âïëèâàþòü íà âèá³ð ó ðåàá³ë³òàö³¿. Ìè
ïîâèíí³ óñâ³äîìëþâàòè, ùî êóëüòóðàëüí³
â³äì³ííîñò³ ìîæóòü âïëèíóòè íà ðåçóëüòàò ë³êóâàí-
íÿ. Åòè÷í³ òà êóëüòóðàëüí³ ïèòàííÿ ïîâèíí³ áóòè
130 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
÷àñòèíîþ íàâ÷àëüíèõ ïðîãðàì ðåàá³ë³òàö³¿ òà
ï³ñëÿäèïëîìíîãî íàâ÷àííÿ. Ïðîôåñ³îíàëàì, ÿê³
íàäàþòü ïîñëóãè ÔÐÌ, íåîáõ³äíî âèä³ëèòè ÷àñ,
ùîá îáì³ðêóâàòè ö³ ïèòàííÿ.
Ðåçóëüòàòè âòðó÷àíü òà ïðîãðàì ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
Îñê³ëüêè ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà
âèçíà÷àºòüñÿ ÿê «ìåäèöèíà ôóíêö³îíóâàííÿ» ç
«ðåàá³ë³òàö³ºþ» â ÿêîñò³ îñíîâíî¿ ñòðàòå㳿 3,4,43,
«ôóíêö³îíóâàííÿ», à òàêîæ ð³çí³ àñïåêòè ÿêîñò³
æèòòÿ ³ ñïðèéíÿòòÿ çäîðîâ’ÿ ³ áëàãîïîëó÷÷ÿ4,44 º
íàéá³ëüø âàæëèâèìè ö³ëÿìè ë³êóâàííÿ ³ ïðîãðàì
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. Òîìó íåîä-
ì³ííèì ðåçóëüòàòîì, ñïåöèô³÷íèì äëÿ ÔÐÌ, º
«ôóíêö³îíóâàííÿ».
²ñíóº áàãàòî ïðèêëàä³â òîãî, ùî ïðîãðàìè ÔÐÌ
òà ðåàá³ë³òàö³éí³ ïîñëóãè ïîêàçàëè åôåêòèâí³ñòü â
ïîêðàùåíí³ ôóíêö³îíóâàííÿ (ôóíêö³îíàëüíèõ ðåçóëü-
òàò³â) òà çìåíøåíí³ îáìåæåíü æèòòºä³ÿëüíîñò³.
Âàæëèâ³ñòü ôóíêö³îíàëüíèõ ðåçóëüòàò³â
Ôóíêö³îíàëüí³ ðåçóëüòàòè ïîâ’ÿçàí³ ç òðüîìà
âèì³ðàìè, âêëþ÷àþ÷è ôóíêö³¿ òà ñòðóêòóðè îðãà-
í³çìó, àêòèâí³ñòü òà ó÷àñòü, ÿê öå âèçíà÷åíî â çà-
ãàëüíîìó òåðì³í³ «ôóíêö³îíóâàííÿ» â ̳æíàðîäí³é
êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ, îáìåæåíü æèòòºä³-
ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ)5, ùî îõîïëþº ñôåðè
æèòòÿ, âêëþ÷àþ÷è ðîçóì³ííÿ ³ ñï³ëêóâàííÿ,
ìîá³ëüí³ñòü, ñàìîîáñëóãîâóâàííÿ, âçàºìîä³þ ç
³íøèìè ëþäüìè, äîìàøíº æèòòÿ, ðîáîòó/ïðàöå-
âëàøòóâàííÿ, øêîëó, â³äïî÷èíîê òà ïðèºäíàííÿ äî
ãðîìàäñüêî¿ ä³ÿëüíîñò³ / ó÷àñòü ó ñóñï³ëüñòâ³5,45.
Ôóíêö³îíóâàííÿ ïðèòàìàííå âñ³ì ëþäñüêèì ³ñòî-
òàì, ³ áóäü-ÿêà îñîáà ìîæå çàçíàâàòè ïðîáëåì
ôóíêö³îíóâàííÿ, ùî âàð³þþòü â³ä ëåãêèõ äî âàæ-
êèõ, ïðîòÿãîì éîãî/¿¿ æèòòÿ46. Êîíñåíñóñíèé ïîãëÿä
Âñåñâ³òíüî¿ îðãàí³çàö³¿ îõîðîíè çäîðîâ’ÿ (ÂÎÎÇ)
ïîëÿãຠâ òîìó, ùî çäîðîâ’ÿ – öå íå ïðîñòî
â³äñóòí³ñòü ïåâíîãî çàõâîðþâàííÿ àáî òðàâìè, àëå
âîíî ì³ñòèòü ôóíêö³îíóâàííÿ (íàïð. çäàòí³ñòü âè-
êîíóâàòè ô³çè÷í³ òà ðîçóìîⳠ䳿 / çàâäàííÿ) 47.
Îòæå, ôóíêö³îíóâàííÿ º îñíîâíèì åëåìåíòîì çäî-
ðîâ’ÿ òà ïîêðàùåííÿ ôóíêö³îíàëüíèõ ðåçóëüòàò³â
º æèòòºâî âàæëèâîþ ìåòîþ.
ijéñíî, äàí³ ñâ³ä÷àòü ïðî òå, ùî ð³âåíü ôóíêö³-
îíóâàííÿ îñîáè ó âçàºìî䳿 ç ïîòî÷íèì ñåðåäîâè-
ùåì, ùî íàçèâàºòüñÿ «çäîðîâ’ÿ æèòòÿ», º á³ëüø
âàæëèâèì, í³æ á³îëîã³÷íå çäîðîâ’ÿ. Áóëî ïîêàçà-
íî, ùî çàãàëüíå çäîðîâ’ÿ, ÿêå áåçïîñåðåäíüî îïè-
ñóºòüñÿ îñîáîþ, º äóæå àêòóàëüíèì ó âåëèê³é êî-
ãîðò³ ç áëèçüêî â³ñ³ìíàäöÿòè òèñÿ÷ îñ³á, ÿê³ æèâóòü
ó ñï³ëüíîò³ òà áëèçüêî äåñÿòè òèñÿ÷ îñ³á, ùî ïå-
ðåáóâàþòü ó çàêëàäàõ ç äîãëÿäó. Ñïðèéíÿòòÿ çà-
¹2(2) *2018
 ÐÎÇÄ²Ë 7 – ÑÔÅÐÀ Ê˲Ͳ×ÍÈÕ ÊÎÌÏÅÒÅÍÒÍÎÑÒÅÉ: ÔÐÌ ÍÀ ÏÐÀÊÒÈÖ²
ãàëüíîãî çäîðîâ’ÿ â ïîïóëÿö³¿ îñ³á â çàêëàäàõ ç
äîãëÿäó ç á³ëüø íèçüêèì ð³âíåì á³îëîã³÷íîãî çäî-
ðîâ’ÿ áëèæ÷å äî ñïðèéíÿòòÿ ñåðåä ïîïóëÿö³¿, ÿêà
ìåøêຠâ ãðîìàä³, ïðè çàáåçïå÷åíí³ äîïîì³æíèìè
ïðèñòðîÿìè òà/àáî ñòîðîííüîþ äîïîìîãîþ48. Öåé
âèñíîâîê ÷³òêî âêàçóº íà ö³íí³ñòü ³ âàæëèâ³ñòü ôóí-
êö³îíàëüíèõ ðåçóëüòàò³â, ÿê³ êîíêðåòíî ñòîñóþòü-
ñÿ ÔÐÌ, ïðè îö³íêè çäîðîâ’ÿ ç òî÷êè çîðó ëþäåé.
Íà çàê³í÷åííÿ, ðåàëüíà äîïîìîãà ôóíêö³îíàëüíèì
ðåçóëüòàòàì, ùî çàáåçïå÷óþòüñÿ ï³äõîäàìè ÔÐÌ,
ÿê³ ôîêóñóþòüñÿ íà ôóíêö³¿, î÷åâèäíî, º ð³÷÷þ, ÿêà
º äóæå âàæëèâîþ äëÿ ëþäåé. ²í³ö³àòèâà ÂÎÎÇ
ùîäî ³íòåãðîâàíîãî âèêîðèñòàííÿ ̳æíàðîäíî¿ ñòà-
òèñòè÷íî¿ êëàñèô³êàö³¿ õâîðîá òà ñïîð³äíåíèõ ïðî-
áëåì îõîðîíè çäîðîâ’ÿ (ÌÊÕ)19 òà ÌÊÔ5 â ïðîöåñ³
ïåðåãëÿäó ÌÊÕ, ñïðÿìîâàíîãî íà ïðåäñòàâëåííÿ
âïëèâó ñòàíó çäîðîâ’ÿ íà ôóíêö³îíóâàííÿ, º âàæëè-
âèì çàõîäîì35, ÿêèé ï³äêðåñëþº âàæëèâ³ñòü ôóíêö-
³îíàëüíîãî ðåçóëüòàòó â ÔÐÌ.
Ïàö³ºíò-öåíòðè÷í³ ðåçóëüòàòè
Ïåðâèííà â³äïîâ³äàëüí³ñòü ë³êàð³â ÔÐÌ ïîëÿ-
ãຠâ òîìó, ùîá ïðîäóêóâàòè ðåçóëüòàòè ë³êóâàí-
íÿ, ÿê³ âïëèâàþòü íà æèòòÿ ëþäåé â³äïîâ³äíî äî
¿õ ö³ííîñòåé. Ìîæíà ñòâåðäæóâàòè, ùî, íåçâàæà-
þ÷è íà òå, ùî ë³êàð³ ÔÐÌ çâåðòàþòü óâàãó íà
ÿê³ñòü æèòòÿ îñîáè â ö³ëîìó, ô³çè÷íà òà ðåàá³ë³òà-
ö³éíà ìåäèöèíà íàö³ëåíà íà ÿê³ñòü æèòòÿ, ùî ïî-
â’ÿçàíà ç³ çäîðîâ’ÿì, ÿêå ñòàíîâèòü âàæëèâó ÷àñ-
òèíó ö³ëî¿ ÿêîñò³ æèòòÿ49.
Òîìó ðåçóëüòàòè â ô³çè÷í³é òà ðåàá³ë³òàö³éí³é
ìåäèöèí³ ïîâ’ÿçàí³ ç ð³çíèìè àñïåêòàìè ÿêîñò³
æèòòÿ, ïîâ’ÿçàíîãî ç³ çäîðîâ’ÿì, âíàñë³äîê ïî-
ë³ïøåíü ôóíêö³îíóâàííÿ òà/àáî ñïðèéíÿòòÿ çäîðî-
â’ÿ ³ áëàãîïîëó÷÷ÿ4,44. Äåìîíñòðàö³ÿ áëàãîïîëó÷-
÷ÿ òà ñîö³àëüíî¿ ó÷àñò³ ëþäèíè º âàæëèâîþ ðèñîþ
îñíîâíîãî ðåçóëüòàòó ðåàá³ë³òàö³¿, îð³ºíòîâàíî¿ íà
ïàö³ºíòà50. Áëàãîïîëó÷÷ÿ, éìîâ³ðíî, º á³ëüø íàä³é-
íèì ïîêàçíèêîì óñï³õó, í³æ ÿê³ñòü æèòòÿ. Áàãàòî
ñó÷àñíèõ ïîêàçíèê³â ÿêîñò³ æèòòÿ áåççàñòåðåæíî
äîçâîëÿþòü ñóäèòè ïðî çíà÷óù³ñòü ñïåöèô³÷íèõ
îá’ºêòèâíèõ ôàêòîð³â, òàêèõ ÿê, íàïð. çäàòí³ñòü
ï³äí³ìàòèñÿ ïî ñõîäàõ, ÿêà íå ìîæå ñïðèéìàòèñÿ
îäíàêîâî âàæëèâîþ óñ³ìà îñîáàìè ç îáìåæåííÿ-
ìè æèòòºä³ÿëüíîñò³1,2.
Ùîá âèïðàâäàòè î÷³êóâàííÿ îñîáè, ñï³ëüíå
âñòàíîâëåííÿ ö³ëåé º öåíòðàëüíèì ïóíêòîì ô³çè÷-
íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè ³ îñíîâíîþ êîìïå-
òåíòí³ñòþ ë³êàð³â ÔÐÌ ³ ðåàá³ë³òàö³éíî¿ êîìàíäè.
Âñòàíîâëåííÿ ö³ëåé ïîâ’ÿçàíå ç ïîêðàùåííÿì ðå-
çóëüòàò³â ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè, à
òàêîæ îö³íêîþ ðåçóëüòàò³â ë³êóâàííÿ51. Âçàºìíî
óçãîäæåí³ ö³ë³ òà ðåçóëüòàòè º îñíîâîþ ïðîöåñó
ðåàá³ë³òàö³¿, ùî îð³ºíòîâàíà íà îñîáó òà ö³ëü ç ïð³î-
ðèòèçàö³ºþ ôóíêö³îíàëüíèõ ðåçóëüòàò³â. ²íñòðó-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ìåíòè ÌÊÔ, òàê³ ÿê ICF Categorical Profile, ICF
Evaluation Display òà ICF Assessment Sheets, ìî-
æóòü áóòè âèêîðèñòàí³ äëÿ ³äåíòèô³êàö³¿, âèçíà÷åí-
íÿ òà ³ëþñòðàö³¿ ö³ëåé ðåàá³ë³òàö³¿, ö³ëåé âòðó÷àí-
íÿ òà äîñÿãíåííÿ ö³ëåé 13 . Îö³íþâàííÿ çì³í
ôóíêö³îíóâàííÿ ï³ñëÿ ö³ëü- òà ðåçóëüòàò-ñïðÿìî-
âàíîãî ðåàá³ë³òàö³éíîãî âòðó÷àííÿ òà äîñÿãíåííÿ
ö³ëåé º ïîêàçîâîþ ì³ðîþ ðåçóëüòàòó â ðåàá³ë³òà-
ö³éíèõ çàêëàäàõ17. Íà ³íäèâ³äóàëüíîìó ð³âí³ ì³ðà
ðåçóëüòàòó º äóæå âàæëèâîþ äëÿ äåìîíñòðàö³¿ äî-
êàç³â åôåêòèâíîñò³ îêðåìèõ ðåàá³ë³òàö³éíèõ âòðó-
÷àíü òà ïîñëóã. Ö³ ì³ðè ðåçóëüòàòó ïîâèíí³ áóòè
áåçïîñåðåäíüî ïîâ’ÿçàíèìè ç³ ñïåöèô³÷íî âèçíà÷å-
íèìè ö³ëÿìè, çàçíà÷åíèìè â ïëàí³ ðåàá³ë³òàö³¿.
Îö³íêà ðåàá³ë³òàö³¿ ìຠôóíäàìåíòàëüí³ â³äì³ííîñò³
â³ä îö³íêè â ìåäè÷í³é äîïîìîç³, ùî îð³ºíòîâàíà íà
õâîðîáó, ÿêà ñïðÿìîâàíà íà îáìåæåííÿ ïàòîëî㳿
àáî ë³êóâàííÿ õâîðîáè1,2. Âàæëèâî âèçíà÷èòè, ÿêèé
ðåçóëüòàò òðåáà âèì³ðÿòè ïðè ³íäèâ³äóàëüíî-îð³ºí-
òîâàíîìó ï³äõîä³ âèì³ðþâàííÿ ðåçóëüòàò³â äëÿ
âèçíà÷åííÿ, ÷è áóëè äîñÿãíóò³ ñïåöèô³÷í³ ö³ë³ äëÿ
êîíêðåòíî¿ îñîáè. ßêùî ïðîáëåìîþ îñîáè º ïîðó-
øåíà ôóíêö³ÿ, òîä³ ïåðâèííèé ðåçóëüòàò ïîâèíåí
ñòîñóâàòèñÿ âèì³ðó ö³º¿ ôóíêö³¿. ßêùî ìåòîþ º
äîñÿãíåííÿ «ó÷àñò³ â ñîö³àëüíîìó æèòò³», òî â
ÿêîñò³ ïåðâèííîãî ðåçóëüòàòó ìຠáóòè âèì³ðÿíî
îáìåæåííÿ ó÷àñò³28. Îö³íêè ïàö³ºíò-îð³ºíòîâàíèõ
ðåçóëüòàò³â â äîñë³äæåííÿõ ñëóæàòü íàð³æíèìè
êàì³ííÿìè äëÿ äîêàçîâî¿ ìåäèöèíè, ÿêà âèçíà-
÷àºòüñÿ ÿê «³íòåãðàö³ÿ êðàùèõ íàóêîâèõ äàíèõ ç
êë³í³÷íèìè çíàííÿìè ³ ö³ííîñòÿìè ïàö³ºíò³â» 52.
Äîêàçîâà ïðàêòèêà ïîêðàùóº ðåçóëüòàòè äîïîìîãè,
ÿêùî äîñÿãàºòüñÿ íàéêðàùèé êîìïðîì³ñ ì³æ âèçíà-
÷åíèìè ö³ëÿìè îñîáè (ö³ëÿìè, ÿê³ º âàæëèâèìè òà
çíà÷óùèìè äëÿ ëþäåé) òà ïëàíîì ðåàá³ë³òàö³¿.
 ðåçóëüòàò³, ðåàá³ë³òàö³ÿ ìຠìîæëèâ³ñòü çíè-
çèòè òÿãàð îáìåæåíü æèòòºä³ÿëüíîñò³ ÿê äëÿ ëþ-
äåé, òàê ³ äëÿ ñóñï³ëüñòâà. Ïîêàçàíî, ùî âîíà º
åôåêòèâíîþ ó ï³äâèùåíí³ ³íäèâ³äóàëüíîãî ôóíêö³î-
íóâàííÿ òà ñàìîñò³éíîãî æèòòÿ øëÿõîì äîñÿã-
íåííÿ á³ëüøî¿ àêòèâíîñò³, ë³ïøîãî çäîðîâ’ÿ òà
çìåíøåííÿ óñêëàäíåíü òà íàñë³äê³â ñóïóòí³õ çàõ-
âîðþâàíü. Öå äîïîìàãຠ³íäèâ³äóóìó òà ñóñï³ëü-
ñòâó ó á³ëüø³é îñîáèñò³é àâòîíî쳿, ïîë³ïøåíí³
ìîæëèâîñòåé ïðàöåâëàøòóâàííÿ òà ³íø³é çà-
íÿòòºâ³é àêòèâíîñò³. Íåçâàæàþ÷è íà òå, ùî ó ïî-
âåðíåíí³ äî ñàìîñò³éíîãî æèòòÿ òà ïðàö³ çàëó÷åíî
áàãàòî ñîö³àëüíèõ ôàêòîð³â, ÔÐÌ ìîæå ï³äãîòó-
âàòè ëþäèíó òà ðîäèíó/äîãëÿäà÷³â äî îòðèìàííÿ
ìàêñèìàëüíî¿ ïåðåâàãè íàÿâíèõ ìîæëèâîñòåé1,2.
Ðåçóëüòàòè ùîäî ö³íè-åôåêòèâíîñò³
Åôåêòèâí³ñòü ðåàá³ë³òàö³¿ ïîâ’ÿçàíà íå ò³ëüêè ç
ïîë³ïøåííÿì ôóíêö³îíóâàííÿ ³ íåçàëåæíèì æèò-
òÿì, àëå ³ ç³ çíèæåííÿì ö³íè çàëåæíîñò³ âíàñë³äîê
131
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
îáìåæåíü æèòòºä³ÿëüíîñò³1,2. Âïëèâ ô³çè÷íî¿ òà
ðåàá³ë³òàö³éíî¿ ìåäèöèíè íà åêîíîì³þ êîøò³â áóëî
îáãîâîðåíî ó ãëàâ³ ïðî åêîíîì³÷íèé òÿãàð îáìå-
æåíü æèòòºä³ÿëüíîñò³.
Ðåçóëüòàòè ùîäî âèæèâàííÿ
Íàðåøò³, ðåçóëüòàòè ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè òàêîæ ïîâ’ÿçàí³ ç âèæèâàííÿì. ²ñíóº
÷èìàëî äîêàç³â òîãî, ùî ðåàá³ë³òàö³ÿ çìåíøóº ðè-
çèê ñìåðòíîñò³ â äåÿêèõ ãðóïàõ ïàö³ºíò³â, ³ ïðèêëà-
äîì ìîæå áóòè ñåðöåâî-ñóäèííà ðåàá³ë³òàö³ÿ íà
îñíîâ³ ô³çè÷íèõ âïðàâ äëÿ ïàö³ºíò³â ç õâîðîáîþ êî-
ðîíàðíèõ àðòåð³é, ùî ïðèçâîäèòü äî çíèæåííÿ ñåð-
öåâî-ñóäèííî¿ ñìåðòíîñò³53. ²ñíóþòü ³íø³ ïðèêëà-
äè, êîëè ðåàá³ë³òàö³ÿ ïîêàçàëà ñâîþ åôåêòèâí³ñòü
ó ïîë³ïøåíí³ âèæèâàííÿ.
Ðåàá³ë³òàö³ÿ ìîæå áóòè óñï³øíî äîñÿãíóòà â
óìîâàõ, êîëè íå â³äáóâàºòüñÿ á³îëîã³÷íå â³äíîâëåí-
íÿ, ³ íàâ³òü ïðè ñòàíàõ, ÿê³ ïåð³îäè÷íî àáî ïîñò³éíî
ïîã³ðøóþòüñÿ.  îñòàííüîìó âèïàäêó ðåàá³ë³òàö³ÿ
ìîæå ïîòðåáóâàòèñÿ ó âèãëÿä³ ïîñò³éíî¿ ïðîãðàìè,
ùî äîçâîëèòü ïàö³ºíòîâ³ ï³äòðèìóâàòè ð³âåíü
ó÷àñò³ òà áëàãîïîëó÷÷ÿ, ÿê³ ³íàêøå íå áóäóòü äî-
ñÿãíóò³. Àóäèò öèõ ïîñëóã º ñòàíäàðòíîþ ïðàêòè-
êîþ 1,2.
Íà çàê³í÷åííÿ, ïðîãðàìè ô³çè÷íî¿ òà ðåàá³ë³òà-
ö³éíî¿ ìåäèöèíè òà ðåàá³ë³òàö³éí³ ïîñëóãè äëÿ ëþ-
äåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ ôîðìóþòü
êîíêðåòíó äîïîìîãó, âêëþ÷àþ÷è ïîë³ïøåííÿ ôóí-
êö³îíóâàííÿ (çà ðàõóíîê çíèæåííÿ ïîðóøåíü
ôóíêö³é îðãàí³çìó, îáìåæåíü àêòèâíîñò³ ³ îáìå-
æåíü ìîæëèâîñò³ ó÷àñò³) ³ çíèæåííÿ âèòðàò, à òà-
êîæ çíèæåííÿ ñìåðòíîñò³ äëÿ ïåâíèõ ãðóï
ïàö³ºíò³â, ùî âèïðàâäîâóþòü âàæëèâ³ñòü ðåçóëü-
òàò³â ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. Âèì³-
ðþâàííÿ ðåçóëüòàò³â çàõîä³â, ïîâ’ÿçàíèõ ç ôóíêö-
³îíóâàííÿì, òà ÿê³ îð³ºíòîâàí³ íà ïàö³ºíòà, ïîâèíí³
ðîçãëÿäàòèñÿ ÿê ïåðâèííèé ðåçóëüòàò ó êë³í³÷íèõ
äîñë³äæåííÿõ ðåàá³ë³òàö³¿.
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Visser-Meily J.M.A., van Berlekom S.B. Validity of the
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2016;7:73–80.
94. Van D.E., Velde D., Bracke P., Van Hove G., Josephsson S.,
Viaene A., DE Boever E., et al. Measuring participation when
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¹2(2) *2018
 ÐÎÇÄ²Ë 7 – ÑÔÅÐÀ Ê˲Ͳ×ÍÈÕ ÊÎÌÏÅÒÅÍÒÍÎÑÒÅÉ: ÔÐÌ ÍÀ ÏÐÀÊÒÈÖ²

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Christoph
Gutenbrunner, Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Carlotte
Kiekens, Sasa Moslavac, Enrique Varela-Donoso, Anthony B Ward, Mauro Zampolini, Stefano Negrini.
• Ó÷àñíèêè: Filipe Antunes, Ayse A. Kucukdeveci, Aydan Oral, Peter Takac, Catarina Aguiar Branco, Mark
Delargy, Alessandro Giustini, Jean-Jacques Glaesener, Klemen Grabljevec, Karol Hornacek, Slavica Dj.
Jandric, Wim G.M. Janssen, Jolanta Kujawa, Renato Nunes, Rajiv K Singh, Aivars Vetra, Jiri Votava, Mauro
Zampolini, Alain Delarque, Gabor Fazekas, Francesca Gimigliano, Vera Neumann, Tatjana Paternostro-
Sluga, Othmar Schuhfried, Luigi Tesio, Tonko Vlak, Alain Yelnik.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ

Äîäàòîê 1. – Êîíöåïòóàëüíèé îïèñ Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè, áàçîâàíèé íà ÌÊÔ

Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà – öå ìåäè÷íà ñïåö³àëüí³ñòü, ÿêà ñïèðàºòüñÿ íà ³íòåãðàòèâíó ìîäåëü ôóíêö³îíóâàííÿ,
îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ ÂÎÎÇ òà ðåàá³ë³òàö³þ, ùî º ¿¿ îñíîâíîþ ñòðàòå㳺þ îõîðîíè çäîðîâ’ÿ,
ä³àãíîñòóº ñòàíè çäîðîâ’ÿ
îö³íþº ôóíêö³îíóâàííÿ â³äíîñíî äî ñòàí³â çäîðîâ’ÿ, îñîáèñòèõ ôàêòîð³â òà ôàêòîð³â ñåðåäîâèùà
âèêîíóº, çàñòîñîâóº òà / àáî ïðèçíà÷ຠá³îìåäè÷í³ òà òåõíîëîã³÷í³ âòðó÷àííÿ äëÿ ë³êóâàííÿ ñòàí³â çäîðîâ’ÿ äëÿ òîãî, ùîá:
ñòàá³ë³çóâàòè, ïîë³ïøóâàòè àáî â³äíîâëþâàòè ïîðóøåí³ ôóíêö³¿ òà ñòðóêòóðè îðãàí³çìó
çàïîá³ãòè ïîðóøåííÿì òà ìåäè÷íèì óñêëàäíåííÿì òà êåðóâàòè ðèçèêàìè
êîìïåíñóâàòè â³äñóòí³ñòü àáî âòðàòó ôóíêö³é òà ñòðóêòóð îðãàí³çìó
î÷îëþº òà êîîðäèíóº ïðîãðàìè âòðó÷àííÿ äëÿ îïòèì³çàö³¿ àêòèâíîñò³ òà ó÷àñò³
ó ïàö³ºíò-öåíòðè÷íîìó ïðîöåñ³ âèð³øåííÿ ïðîáëåì
ó ïàðòíåðñòâ³ ì³æ îñîáîþ òà íàäàâà÷åì òà/àáî äîãëÿäà÷åì òà â ðîçóì³íí³ ñïðèéíÿòòÿ îñîáîþ éîãî àáî ¿¿ ì³ñöÿ â æèòò³
âèêîíóþ÷è, çàñòîñîâóþ÷è òà ³íòåãðóþ÷è á³îìåäè÷í³ òà òåõíîëîã³÷í³ âòðó÷àííÿ, ïñèõîëîã³÷í³ òà ïîâåä³íêîâ³, íàâ÷àëüí³
òà êîíñóëüòàö³éí³, çàíÿòòºâ³ òà ïðîôåñ³éí³, ñîö³àëüí³ òà ï³äòðèìóþ÷³ âòðó÷àííÿ, à òàêîæ âòðó÷àííÿ, ñïðÿìîâàí³ íà
ô³çè÷íå ñåðåäîâèùå
íàäຠïîðàäè ïàö³ºíòàì òà ¿õ íàéáëèæ÷îìó ñîö³àëüíîìó ñåðåäîâèùó, ïîñòà÷àëüíèêàì ïîñëóã òà ïëàòíèêàì
ïðîòÿãîì ïåðåá³ãó ñòàíó çäîðîâ’ÿ,
äëÿ âñ³õ â³êîâèõ ãðóï
âïðîäîâæ òà ÷åðåç êîíòèíóóì äîïîìîãè,
âêëþ÷àþ÷è ë³êàðí³, ðåàá³ë³òàö³éí³ çàêëàäè òà ãðîìàäè, ³ ì³æ ñåêòîðàìè
âêëþ÷àþ÷è îõîðîíó çäîðîâ’ÿ, îñâ³òó, ðîáîòó òà ñîö³àëüí³ â³äíîñèíè;
çàáåçïå÷óº îñâ³òó ïàö³ºíò³â, ðîäè÷³â òà ³íøèõ âàæëèâèõ îñ³á äëÿ ïðîìîòóâàííÿ ôóíêö³îíóâàííÿ òà çäîðîâ’ÿ,
óïðàâëÿº ðåàá³ë³òàö³ºþ òà îõîðîíîþ çäîðîâ’ÿ ó âñ³õ ñôåðàõ ïîñëóã îõîðîíè çäîðîâ’ÿ
³íôîðìóº òà êîíñóëüòóº ãðîìàäñüê³ñòü òà îñ³á, ùî óõâàëþþòü ð³øåííÿ, ùîäî â³äïîâ³äíî¿ ïîë³òèêè òà ïðîãðàì ó ñåêòîð³
îõîðîíè çäîðîâ’ÿ òà ³íøèõ ñåêòîðàõ, ÿê³
çàáåçïå÷óþòü òà çá³ëüøóþòü ñïðèÿòëèâå ô³çè÷íå òà ñîö³àëüíå ñåðåäîâèùå;
çàáåçïå÷óþòü äîñòóïí³ñòü ðåàá³ë³òàö³éíèõ ïîñëóã, ÿê ïðàâà ëþäèíè;
òà ï³äñèëþþòü ôàõ³âö³â ÔÐÌ ç íàäàííÿ ñâîº÷àñíî¿ òà åôåêòèâíî¿ äîïîìîãè
ç ö³ëëþ
óìîæëèâëåííÿ îñîáàì ç³ ñòàíàìè çäîðîâ’ÿ, ùî çàçíàþòü, àáî ìîæóòü çàçíàòè îáìåæåíü æèòòºä³ÿëüíîñò³, äîñÿãíåííÿ
òà ï³äòðèìêè îïòèìàëüíîãî ôóíêö³îíóâàííÿ ó âçàºìî䳿 ç³ ñâî¿ì ñåðåäîâèùåì.

Òåðì³íè ÌÊÔ ïîçíà÷åí³ æèðíèì øðèôòîì

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 135
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Äîäàòîê 2. – Ïîâíèé ñïèñîê ñòàí³â, ÿê³ ë³êóþòü ë³êàð³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
àáî äî ÿêèõ ìîæóòü áóòè çàëó÷åí³
Òàáëèöÿ àäàïòîâàíà ç Á³ëî¿ êíèãè ç ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè â ªâðîï³1,2 ³ ç³ ñòàòò³, ÿêà îïèñóº ñôåðó êîìïåòåí-
òíîñòåé ë³êàð³â ÔÐÌ18, òà ðîçøèðåíà ç âèêîðèñòàííÿì ñïèñêó, ñòâîðåíîãî ï³ä ÷àñ ñåì³íàðó ç ñòàí³â, ùî ï³äëÿãàþòü äî
ÌÊÕ Õ²20,21. Ïóáë³êàö³¿, ùî ñòîñóþòüñÿ ðåàá³ë³òàö³éíèõ ïîòðåá îñ³á ç ïåâíèìè ñòàíàìè çäîðîâ’ÿ òà äîñë³äíèöüêî¿ ä³ÿëüíîñò³
ë³êàð³â ÔÐÌ, ìîæíà çíàéòè â ïîñèëàííÿõ, ùî äîäàþòüñÿ.
Òðàâìàòè÷í³ çàõâîðþâàííÿ: ÷åðåïíî-ìîçêîâà òðàâìà, ñïèííîìîçêîâà òðàâìà, ñïîëó÷íà òðàâìà, ïîøêîäæåííÿ ïåðèôåðè÷íèõ íåðâ³â
³ ñïëåò³íü, ñïîðòèâíà òðàâìà / ïîøêîäæåííÿ, òðàâìà ïðîòÿãîì òðèâàëîãî çàõâîðþâàííÿ, ùî îáìåæóº æèòòºä³ÿëüí³ñòü, âèðîáíè÷à
òðàâìà, òðàâìàòè÷í³ àìïóòàö³¿, ùî çàõîïëþþòü äåê³ëüêà îáëàñòåé ò³ëà, ïîëîãîâà òðàâìà, ïîøêîäæåííÿ äåê³ëüêîõ îáëàñòåé ò³ëà (íàïð.
ïåðåëîì ñòåãíîâî¿ ê³ñòêè òà ³íø³ ïåðåëîìè íèæí³õ ê³íö³âîê, ïåðåëîìè õðåáö³â, ïåðåëîìè âåðõí³õ ê³íö³âîê, òðàâìàòè÷íèé ðîçðèâ
ñóõîæèëê³â àáî çâ’ÿçîê, äåôîðìàö³¿ òà ðîçòÿãíåííÿ ³ç çàëó÷åííÿì çâ’ÿçîê òîùî), îï³êîâà òðàâìà
Íåòðàâìàòè÷í³ çàõâîðþâàííÿ íåðâîâî¿ ñèñòåìè: ³íñóëüò – âêëþ÷íî ³ç ñóáàðàõíî¿äàëüíèì êðîâîâèëèâîì, åêñòðàï³ðàì³äí³ ³ ðóõîâ³
ðîçëàäè, âêëþ÷íî ³ç õâîðîáîþ Ïàðê³íñîíà òà ïàðê³íñîí³çìîì, äèñòîí³¿ (íàïð. ñïàñòè÷íà êðèâîøèÿ òà ³íø³, ñèíäðîì íåñïîê³éíèõ í³ã,
ñèíäðîì ðèã³äíî¿ ëþäèíè), ìíîæèííèé ñêëåðîç, ³íôåêö³¿ àáî àáñöåñè öåíòðàëüíî¿ íåðâîâî¿ ñèñòåìè (ÖÍÑ), âêëþ÷àþ÷è íàñë³äêè òó-
áåðêóëüîçó öåíòðàëüíî¿ íåðâîâî¿ ñèñòåìè, ïîë³î쳺ë³òó), ïóõëèíè ÖÍÑ, ïàðàë³÷ âíàñë³äîê óðàæåííÿ ñïèííîãî ìîçêó, íåçàëåæíî â³ä
ïðè÷èíè, ñêëàäí³ íàñë³äêè íåéðîõ³ðóðã³÷íèõ âòðó÷àíü, ì’ÿçîâà äèñòðîô³ÿ òà íåðâîâî-ì’ÿçîâ³ ðîçëàäè, ñèñòåìí³ àòðîô³¿, ùî óðàæóþòü
ÖÍÑ (íàïð. àòàêñ³¿, ñï³íàëüí³ ì’ÿçîâ³ àòðîô³¿, õâîðîáè ìîòîíåéðîíó, âêëþ÷àþ÷è á³÷íèé àì³îòðîô³÷íèé ñêëåðîç, ïîñò-ïîë³î쳺ë³òíèé
ñèíäðîì), ³íø³ äåãåíåðàòèâí³ çàõâîðþâàííÿ íåðâîâî¿ ñèñòåìè (íàïð. õâîðîáà Àëüöãåéìåðà), ³íø³ ïàðàë³òè÷í³ ñèíäðîìè (íàïð. ñèíäðîì
«çàìêíóòî¿ ëþäèíè»), ïåðèôåðè÷í³ íåéðîïàò³¿ (âêëþ÷íî ³ç ïîë³ðàä³êóëîïàò³ºþ óºíà-Áàððå), ñòèñíåííÿ/êîìïðåñ³ÿ íåðâó, âðîäæåí³ çàõ-
âîðþâàííÿ (öåðåáðàëüíèé ïàðàë³÷, spina bifida òîùî), åï³çîäè÷í³ ³ ïàðîêñèçìàëüí³ ðîçëàäè, ùî ìàþòü â³äíîøåííÿ äî ðåàá³ë³òàö³¿ (íàïð.
åï³ëåïñ³ÿ, ñèíäðîì âåðòåáðî-áàçèëÿðíî¿ àðòåð³¿, ïîðóøåííÿ ñíó), ìåòàáîë³÷í³ àáî á³îõ³ì³÷í³ ãåíåòè÷í³ çàõâîðþâàííÿ.
Ïñèõ³÷í³ òà ïîâåä³íêîâ³ ðîçëàäè, ùî ìàþòü â³äíîøåííÿ äî ðåàá³ë³òàö³¿ (íàïð. äåìåíö³ÿ, á³ïîëÿðíèé àôåêòèâíèé ðîçëàä, ï³ñëÿòðàâ-
ìàòè÷íèé ñòðåñîâèé ðîçëàä, äåïðåñ³ÿ, øèçîôðåí³ÿ)
Ðîçëàäè ïñèõîëîã³÷íîãî ðîçâèòêó, ùî ìàþòü â³äíîøåííÿ äî ðåàá³ë³òàö³¿ (íàïð. äèòÿ÷èé àóòèçì, ñèíäðîì Ðåòòà).
Ïîâåä³íêîâ³ òà åìîö³éí³ ðîçëàäè, ùî çàçâè÷àé ïî÷èíàþòüñÿ â äèòèíñòâ³, ùî ìàþòü â³äíîøåííÿ äî ðåàá³ë³òàö³¿ (íàïð. ðîçëàäè ã³ïåð-
àêòèâíîñò³ ç äåô³öèòîì óâàãè)
Ãîñòðèé àáî õðîí³÷íèé á³ëü âíàñë³äîê ð³çíèõ ïðè÷èí, òàêèõ, ÿê àìïóòàö³ÿ, ñòàí ï³ñëÿ îïåðàö³¿, ïîë³íåéðîïàò³ÿ êðèòè÷íèõ ñòàí³â.
Äåÿê³ çàãàëüí³ ñèìïòîìè ³ îçíàêè, ÿê³ ìàþòü â³äíîøåííÿ äî ÔÐÌ (íàïð. õðîí³÷íèé íåêåðîâàíèé á³ëü, ³íø³ õðîí³÷í³ áîë³, ñëàáê³ñòü,
ëîêàë³çîâàíèé ã³ïåðã³äðîç).
Êîìïëåêñíèé ñòàí âíàñë³äîê ð³çíèõ ³ ìíîæèííèõ ïðè÷èí: ñèíäðîì ïîñò³ëüíîãî ðåæèìó, äåòðåíóâàííÿ, ìóëüòèñèñòåìíà íåäî-
ñòàòí³ñòü
Íåòðàâìàòè÷í³ çàõâîðþâàííÿ ì’ÿçîâî- ñêåëåòíî¿ ñèñòåìè: õðåáòà (õðîí³÷íèé òà ãîñòðèé ïîïåðåêîâèé á³ëü, á³ëü â øè¿ òà ãðóäíîìó
â³ää³ë³), ³íôåêö³éí³, äåãåíåðàòèâí³ òà çàïàëüí³ àðòðîïàò³¿ (ìîíî- ³ ïîë³àðòðèòè) (íàïð. îñòåîàðòðèò, ðåâìàòî¿äíèé àðòðèò, àíê³ëîçóþ÷èé
ñïîíäèë³ò ³ ³íø³ ñïîíäèëîïàò³¿, âêëþ÷àþ÷è ñòåíîç õðåáòà àáî ñïîíäèëîïàò³¿ ïðè òàêèõ çàõâîðþâàííÿõ, ÿê õâîðîáà Ïîòòà àáî áðóöåëüîçíèé
ñïîíäèë³ò), àìïóòàö³¿ âíàñë³äîê ñóäèííèõ çàõâîðþâàíü, ïîðóøåííÿ ì’ÿêèõ òêàíèí, â òîìó ÷èñë³ çàõâîðþâàííÿ ñóõîæèëê³â ³ ñèíîâ³àëüíî¿
îáîëîíêè (íàïð. êàëüöèô³êóþ÷èé òåíäèí³ò, òðèãåðíèé ïàëåöü, òåíîñ³íîâ³ò DeQurvain), ïîðóøåííÿ ì’ÿêèõ òêàíèí, ïîâ’ÿçàí³ ç âèêîðèñòàí-
íÿì, ïåðåâàíòàæåííÿì ³ òèñêîì (íàïð. áóðñèò, õðîí³÷íèé êðåï³òóþ÷èé ñèíîâ³ò êèñò³ ³ çàï’ÿñòêà), ô³áðîáëàñò³÷í³ ðîçëàäè (íàïð. õâîðîáà
Äþïó³òðåíà, ï³äîøîâíèé ôàñö³¿ò), óðàæåííÿ ïëå÷îâîãî ñóãëîáó (íàïð. àäãåçèâíèé êàïñóë³ò, ñèíäðîì ðîòàòîðíî¿ ìàíæåòè, òåíäèí³ò á³öåï-
ñó, êàëüöèô³êóþ÷èé òåíäèí³ò), åíòåçîïàò³¿ ê³íö³âîê (íàïð. åï³êîíäèë³ò, òåíäèí³ò, ³ë³îò³á³àëüíèé ñèíäðîì, ï’ÿòêîâà øïîðà, ìåòàòàðçàëã³ÿ),
³íø³ ïîðóøåííÿ ì’ÿêèõ òêàíèí (íàïð. ì³àëã³ÿ, ô³áðîì³àëã³ÿ), ðîçëàäè ñòðóêòóðè òà ù³ëüíîñò³ ê³ñòêîâî¿ òêàíèíè (íàïð. îñòåîïîðîç, îñòåî-
ìàëÿö³ÿ), ïîðóøåííÿ ö³ë³ñíîñò³ ê³ñòêè (íàïð. óïîâ³ëüíåíà êîíñîë³äàö³ÿ óëàìê³â), ³íø³ ðîçëàäè ê³ñòîê (íàïð. ñèìïàòè÷íà ðåôëåêòîðíà äèñ-
òðîô³ÿ / êîìïëåêñíèé ðåã³îíàëüíèé áîëüîâèé ñèíäðîì), ³íø³ ñóãëîáîâ³ ðîçëàäè, âêëþ÷àþ÷è íàáóò³ äåôîðìàö³¿, ùî óðàæóþòü ê³íö³âêè /
îáëàñò³ ê³íö³âîê, íåð³âíîì³ðíà äîâæèíà ê³íö³âîê, ïàòåëëîôåìîðàëüí³ ðîçëàäè, õîíäðîìàëÿö³ÿ íàäêîë³íêà, âíóòð³øí³ ðîçðèâè â êîë³ííîìó
ñóãëîá³ (íàïð. ðîçðèâè ìåí³ñêà), õðîí³÷íà íåñòàá³ëüí³ñòü, ïîðóøåííÿ çâ’ÿçîê, ñïîíòàííèé ðîçðèâ / íàäðèâ çâ’ÿçîê àáî ñóõîæèëê³â, äèñëî-
êàö³ÿ, ï³äâèâèõ, êîíòðàêòóðà ñóãëîá³â, ãåìàðòðîç, âèï³ò â ñóãëîá), ñèñòåìí³ ïîðóøåííÿ ñïîëó÷íî¿ òêàíèíè, âêëþ÷àþ÷è ³íø³ ðåâìàòè÷í³
ðîçëàäè ³ ñèíäðîì ã³ïåðìîá³ëüíîñò³, äîáðîÿê³ñíèé ì³àëã³÷íèé åíöåôàëî쳺ë³ò (ñèíäðîì õðîí³÷íî¿ âòîìè), ïðîôåñ³éíèé êîíòàêò ç â³áðà-
ö³ºþ (íàïð. ñèíäðîì êèñòü-ïëå÷å), äåôîðìóþ÷³ äîðñîïàò³¿ (íàïð. ê³ôîç ³ ëîðäîç, ñêîë³îç, ñïîíä³ëîë³ç, ñïîíäèëîë³ñòåç, êðèâîøèÿ).
Ïîðóøåííÿ âåñòèáóëÿðíî¿ ôóíêö³¿, ùî ìàþòü â³äíîøåííÿ äî ðåàá³ë³òàö³¿ (íàïð. ãîëîâîêðóæ³ííÿ).
Ñåðöåâî-ñóäèíí³ çàõâîðþâàííÿ: ³øåì³÷íà õâîðîáà ñåðöÿ, ãîñòðèé ³íôàðêò ì³îêàðäà, ñåðöåâà íåäîñòàòí³ñòü, çàõâîðþâàííÿ êëà-
ïàí³â, àòåðîñêëåðîç íèæí³õ ê³íö³âîê, ì³îêàðäèò, ï³äâèùåíèé àðòåð³àëüíèé òèñê, ô³áðèëÿö³ÿ ïåðåäñåðäü, òðàíñïëàíòàö³ÿ ñåðöÿ, õâîðî-
áà Øàãàñà ç óðàæåííÿì ñåðöÿ, ðåâìàòè÷íà õâîðîáà ñåðöÿ.
Çàõâîðþâàííÿ ë³ìôàòè÷íî¿ ñèñòåìè, ùî ìàþòü â³äíîøåííÿ äî ðåàá³ë³òàö³¿ (íàïð. ë³ìôåäåìà âíàñë³äîê ðàêó ìîëî÷íî¿ çàëîçè òà
³íøà ë³ìôåäåìà).
Çàõâîðþâàííÿ ðåñï³ðàòîðíî¿ ñèñòåìè: àñòìà, õðîí³÷íå îáñòðóêòèâíå çàõâîðþâàííÿ ëåãåíü, ëåãåíåâà ã³ïåðòåíç³ÿ, ô³áðîç ëåãåíü,
òðàíñïëàíòàö³ÿ ëåãåíü, ïíåâìîêîí³îç, àçáåñòîç.
Åíäîêðèíí³, õàð÷îâ³ òà ìåòàáîë³÷í³ çàõâîðþâàííÿ: öóêðîâèé ä³àáåò, óñêëàäíåííÿ ìåòàáîë³÷íîãî ñèíäðîìó, îæèð³ííÿ, á³ëêîâî-
åíåðãåòè÷íà íåäîñòàòí³ñòü.
Çàõâîðþâàííÿ ñå÷îñòàòåâî¿ ñèñòåìè ³ øëóíêîâî-êèøêîâîãî òðàêòó: íàïð. ñô³íêòåðí³ ðîçëàäè ñå÷îâîãî ì³õóðà, ñòðåñîâà äèñôóí-
êö³ÿ ñå÷îâîãî ì³õóðà àáî êèøê³âíèêà, íåéðîãåííà äèñôóíêö³ÿ ñå÷îâîãî ì³õóðà ³ êèøê³âíèêà, ñèíäðîì õðîí³÷íîãî òàçîâîãî áîëþ
ñòàòåâ³ ðîçëàäè, õðîí³÷íà íèðêîâà íåäîñòàòí³ñòü.
Õâîðîáè øëóíêîâî-êèøêîâîãî òðàêòó, ùî ìàþòü â³äíîøåííÿ äî ðåàá³ë³òàö³¿ (íàïð. íå³íôåêö³éí³ çàïàëüí³ çàõâîðþâàííÿ êèøê³âíèêà).
Ãåìàòîëîã³÷í³ çàõâîðþâàííÿ: ôóíêö³îíàëüí³ íàñë³äêè ëåéêå쳿, ë³ìôîìè, òðàíñïëàíòàö³ÿ ê³ñòêîâîãî ìîçêó
Ôóíêö³îíàëüí³ íàñë³äêè ðàêó, âêëþ÷àþ÷è ðàê ãîëîâè / øè¿, ðàê ìîëî÷íî¿ çàëîçè, ðàê ò³ëà ìàòêè, ðàê ÿº÷íèê³â, ðàê ï³äøëóíêîâî¿
çàëîçè, ðàê ïåðåäì³õóðîâî¿ çàëîçè, ðàê ñòðàâîõîäó
Íàñë³äêè äåÿêèõ ³íôåêö³éíèõ òà ïàðàçèòàðíèõ çàõâîðþâàíü, ùî ìàþòü â³äíîøåííÿ äî ðåàá³ë³òàö³¿ (íàïð. íàñë³äêè ïðîêàçè, íà-
ñë³äêè ïîë³î쳺ë³òó, ë³ìôàòè÷íèé ô³ëÿð³îç, ²Ë- ³íôåêö³ÿ, ùî ïðèçâîäÿòü äî ìíîæèííèõ ³íøèõ çàõâîðþâàíü, áðóöåëüîç).
Õâîðîáè ùåëåï, ùî ìàþòü â³äíîøåííÿ äî ÔÐÌ (íàïð. ïîðóøåííÿ ñêðîíåâî-íèæíüîùåëåïîâîãî ñóãëîáó)
Óñêëàäíåííÿ ìåäè÷íî¿ òà õ³ðóðã³÷íî¿ äîïîìîãè, ùî ìàþòü â³äíîøåííÿ äî ðåàá³ë³òàö³¿ (íàïð. ïðîìåíåâà òåðàï³ÿ, ÿêà âåäå äî êîí-
òðàêòóð)
Ïîðóøåííÿ, ïîâ’ÿçàí³ ç â³êîì (íàïð. âòðàòà ì’ÿç³â ³ àòðîô³ÿ – ñàðêîïåí³ÿ, ñåí³ëüíà àñòåí³ÿ ³ ñëàáê³ñòü)
²íø³ õâîðîáè ó ä³òåé: âðîäæåíèé ñêîë³îç, þâåí³ëüíèé îñòåîõîíäðîç õðåáòà (íàïð. õâîðîáà Øåéåðìàíà), âðîäæåí³ âàäè ðîçâèòêó
(íàïð. ù³ëèíà ãóáè, ù³ëèíà ï³äíåá³ííÿ, âðîäæåí³ àíîìà볿 ñåðöÿ), õðîìîñîìí³ àíîìà볿 (íàïð. ñèíäðîì Äàóíà)
Ðîçëàäè øê³ðè òà ï³äøê³ðíî¿ òêàíèíè, ùî ìàþòü â³äíîøåííÿ äî ÔÐÌ (íàïð. ïðîëåæí³)

136 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Äîäàòîê 3À: Îãëÿä îö³íþâàíü ïðè îñòåîàðòðèò³

Ç òàêñîíî쳿 ̳æíàðîäíî¿ êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ, îáìåæåíü æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ) òà ÿêîñò³ æèòòÿ
(ßÆ).

Ⱦɨɦɟɧ, ɳɨ ɨɰɿɧɸɽɬɶɫɹ Ɇɟɬɨɞ / ȱɧɫɬɪɭɦɟɧɬ ɨɰɿɧɸɜɚɧɧɹ

Ɏɭɧɤɰɿʀ ɨɪɝɚɧɿɡɦɭ
ȼɿɞɱɭɬɬɹ ɛɨɥɸ ȼɿɡɭɚɥɶɧɚ ɚɧɚɥɨɝɨɜɚ ɲɤɚɥɚ, Numerical Rating Scale, Verbal Rating Scale,
WOMAC-Pain, Multidimensional Pain Inventory, Ɉɩɢɬɭɜɚɥɶɧɢɤ ɛɨɥɸ McGill,
AIMS2-Pain, NHP-Pain, SF-36 Pain, AUSCAN-Pain
Ɏɭɧɤɰɿʀ ɪɭɯɥɢɜɨɫɬɿ ɫɭɝɥɨɛɭ ȼɢɦɿɪɸɜɚɧɧɹ ɨɛ’ɽɦɭ ɪɭɯɿɜ ɜ ɫɭɝɥɨɛɚɯ ɝɨɧɿɨɦɟɬɪɿɽɸ
Ɏɭɧɤɰɿʀ ɦ'ɹɡɨɜɨʀ ɫɢɥɢ ɋɢɥɚ ɡɚɯɜɚɬɭ, ɦɚɧɭɚɥɶɧɢɣ ɦ’ɹɡɨɜɢɣ ɬɟɫɬ, ɿɡɨɤɿɧɟɬɢɱɧɢɣ ɬɟɫɬ
ȼɿɞɱɭɬɬɹ ɫɤɭɬɨɫɬɿ ɦ’ɹɡɿɜ Ɍɪɢɜɚɥɿɫɬɶ ɪɚɧɤɨɜɨʀ ɫɤɭɬɨɫɬɿ, WOMAC-Stiffness, AUSCAN-Stiffness
Ɏɭɧɤɰɿʀ ɟɧɟɪɝɿʀ ɬɚ ɫɩɨɧɭɤɚɧɧɹ ɞɨ ɞɿɣ Multidimensional Assessment of Fatigue Scale, VAS
Ɏɭɧɤɰɿʀ ɩɚɬɟɪɧɭ ɯɨɞɶɛɢ Ⱥɧɚɥɿɡ ɯɨɞɶɛɢ
Ɏɭɧɤɰɿɹ ɫɧɭ Medical Outcomes Study (MOS) Sleep measure
ȿɦɨɰɿɣɧɿ ɮɭɧɤɰɿʀ Hospital Anxiety Depression Scale, Beck Depression Inventory
ɋɬɪɭɤɬɭɪɢ ɨɪɝɚɧɿɡɦɭ
ɋɬɪɭɤɬɭɪɢ, ɩɨɜ’ɹɡɚɧɿ ɡ ɪɭɯɨɦ Ⱦɟɮɨɪɦɚɰɿɹ ɫɭɝɥɨɛɿɜ – ɲɥɹɯɨɦ ɮɿɡɢɤɚɥɶɧɨɝɨ ɨɛɫɬɟɠɟɧɧɹ ɚɛɨ ɜɿɡɭɚɥɿɡɚɰɿʀ
ɉɨɲɤɨɞɠɟɧɧɹ ɫɭɝɥɨɛɿɜ ɲɥɹɯɨɦ ɜɿɡɭɚɥɿɡɚɰɿʀ (Kellgren-Lawrence grading scale)
Ɏɭɧɤɰɿʀ /ɋɬɪɭɤɬɭɪɢ ɨɪɝɚɧɿɡɦɭ / Ⱥɤɬɢɜɧɿɫɬɶ/ɍɱɚɫɬɶ
ȼɚɠɤɿɫɬɶ ɯɜɨɪɨɛɢ / ɫɬɚɧ Ɂɚɝɚɥɶɧɟ ɨɰɿɧɸɜɚɧɧɹ ɩɚɰɿɽɧɬɚ
ɉɨɽɞɧɚɧɧɹ WOMAC, Harris Hip Score, KOOS, Lequesne Index, AUSCAN, Oxford Knee Scale,
Oxford Hip Scale,
Ⱥɤɬɢɜɧɿɫɬɶ ɬɚ ɍɱɚɫɬɶ
Ⱥɤɬɢɜɧɿɫɬɶ WOMAC-Function, Health Assessment Questionnaire, AIMS2-Mobility, AIMS2-
walking&bending, AIMS2-hand&finger function, AIMS2-arm function, AIMS2-
selfcare, AIMS2-household tasks, Cochin Hand Scale, AUSCAN-Physical, Functional
Index for Hand Osteoarthritis
ɍɱɚɫɬɶ AIMS2-social activity, AIMS2-support, AIMS2-work, Work Limitations
Questionnaire
Ⱥɤɬɢɜɧɿɫɬɶ ɬɚ ɍɱɚɫɬɶ London Handicap Scale, WHODAS II
Ɏɚɤɬɨɪɢ ɫɟɪɟɞɨɜɢɳɚ
ɇɚɣɛɥɢɠɱɿ ɪɨɞɢɱɿ ɋɨɰɿɚɥɶɧɢɣ ɚɧɚɦɧɟɡ
ȼɢɪɨɛɢ ɬɚ ɬɟɯɧɨɥɨɝɿʀ ɞɥɹ ɨɫɨɛɢɫɬɨɝɨ Ɏɭɧɤɰɿɨɧɚɥɶɧɢɣ ɚɧɚɦɧɟɡ
ɤɨɪɢɫɬɭɜɚɧɧɹ ɜ ɩɨɜɫɹɤɞɟɧɧɨɦɭ ɠɢɬɬɿ
ɉɨɫɥɭɝɢ, ɫɢɫɬɟɦɢ ɬɚ ɩɨɥɿɬɢɤɚ ɨɯɨɪɨɧɢ ɋɨɰɿɚɥɶɧɢɣ ɚɧɚɦɧɟɡ
ɡɞɨɪɨɜ’ɹ
ɉɪɨɟɤɬɭɜɚɧɧɹ, ɛɭɞɿɜɧɢɰɬɜɨ ɬɚ ɛɭɞɿɜɟɥɶɧɿ ɋɨɰɿɚɥɶɧɢɣ ɚɧɚɦɧɟɡ
ɜɢɪɨɛɢ ɬɚ ɬɟɯɧɨɥɨɝɿʀ ɛɭɞɿɜɟɥɶ ɡɚɝɚɥɶɧɨɝɨ
ɤɨɪɢɫɬɭɜɚɧɧɹ
əɀ/ əɀ, ɩɨɜ’ɹɡɚɧɚ ɡɿ ɡɞɨɪɨɜ’ɹɦ
əɀ SF-36, NHP, EuroQoL, WHOQOL-BREF, OAKHQOL, OAQoL

WOMAC: Western Ontario and McMaster Universities Arthritis Index (²íäåêñ Àðòðèòó Óí³âåðñèòåò³â Çàõ³äíîãî Îíòàð³î òà
ÌàêÌàñòåðà); AIMS2: Arthritis Impact Measurement Scales 2 (Øêàëà âèì³ðþâàííÿ âïëèâó àðòðèòó 2); NHP: Nottingham Health
Profile (Íîòòèíãåìñüêèé ïðîô³ëü çäîðîâ’ÿ); SF-36: Medical Outcomes Study Short Form 36 (Êîðîòêà ôîðìà äîñë³äæåííÿ ìå-
äè÷íèõ ðåçóëüòàò³â 36); AUSCAN: Australian/Canadian Hand Osteoarthritis Index (Àâñòðàë³éñüêî-êàíàäñüêèé ³íäåêñ îñòåîàðò-
ðèòó ðóêè); KOOS: Knee injury and Osteoarthritis Outcome Score (Îö³íêà ðåçóëüòàòó òðàâì òà îñòåîàðòðèòó êîë³ííîãî ñóãëî-
áó); WHODAS II: World Health Organization Disability Assessment Schedule II (Ïðîòîêîë îö³íþâàííÿ îáìåæåíü æèòòºä³ÿëüíîñò³
ÂÎÎÇ ²²); WHOOQOL-BREF: World Health Organization Quality of Life-BREF; OAKHQOL: The osteoarthritis knee and hip quality
of life questionnaire (Îïèòóâàëüíèê ÿêîñò³ æèòòÿ ïðè îñòåîàðòðèò³ êîë³ííîãî òà ñòåãíîâîãî ñóãëîá³â); OAQoL: Osteoarthritis
Quality of Life scale (Øêàëà ÿêîñò³ æèòòÿ ïðè îñòåîàðòðèò³)

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 137
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Äîäàòîê 3Á. – Îãëÿä îö³íþâàíü ïðè ³íñóëüò³

Ç òàêñîíî쳿 ̳æíàðîäíî¿ êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ, îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ) òà ÿêîñò³ æèòòÿ
(ßÆ)

Ⱦɨɦɟɧ, ɳɨ ɨɰɿɧɸɽɬɶɫɹ Ɇɟɬɨɞ / ȱɧɫɬɪɭɦɟɧɬ ɨɰɿɧɸɜɚɧɧɹ

Ɏɭɧɤɰɿʀ ɨɪɝɚɧɿɡɦɭ
Ɏɭɧɤɰɿʀ ɫɜɿɞɨɦɨɫɬɿ ɒɤɚɥɚ ɤɨɦ Ƚɥɚɡɝɨ
Ƚɥɨɛɚɥɶɧɿ ɤɨɝɧɿɬɢɜɧɿ ɮɭɧɤɰɿʀ Mini-mental State Examination, Neurobehavioral Cognitive Status Examination
Ɏɭɧɤɰɿʀ ɩɚɦ'ɹɬɿ Rivermead Behavioural Memory Test
Ɏɭɧɤɰɿʀ ɭɜɚɝɢ Behavioural Inattention Test, Star Cancellation Test
Ɏɭɧɤɰɿʀ ɡɨɪɨɜɨɝɨ ɫɩɪɢɣɧɹɬɬɹ Motor-free Visual Perception Test
ɉɫɢɯɿɱɧɿ ɮɭɧɤɰɿʀ ɦɨɜɥɟɧɧɹ Boston Diagnostic Aphasia Examination
ȿɦɨɰɿɣɧɿ ɮɭɧɤɰɿʀ Beck Depression Inventory, Hospital Anxiety and Depression Scale
Ɏɭɧɤɰɿʀ ɦ'ɹɡɨɜɨʀ ɫɢɥɢ Ɇɚɧɭɚɥɶɧɢɣ ɦ’ɹɡɨɜɢɣ ɬɟɫɬ
Ɏɭɧɤɰɿʀ ɦ'ɹɡɨɜɨɝɨ ɬɨɧɭɫɭ Ɇɨɞɢɮɿɤɨɜɚɧɚ ɲɤɚɥɚ Ashworth, ɒɤɚɥɚ Tardieu
Ɏɭɧɤɰɿʀ ɤɨɧɬɪɨɥɸ ɞɨɜɿɥɶɧɢɯ ɪɭɯɿɜ Fugl-Meyer Assessment, ɫɬɚɞɿʀ ɦɨɬɨɪɧɨɝɨ ɜɿɞɧɨɜɥɟɧɧɹ Brunnstrom’s
ɋɬɪɭɤɬɭɪɢ ɨɪɝɚɧɿɡɦɭ
ɋɬɪɭɤɬɭɪɢ ɦɨɡɤɭ ȼɿɡɭɚɥɿɡɚɰɿɹ: ɆɊɌ, ɄɌ
ɋɬɪɭɤɬɭɪɚ ɜɟɪɯɧɶɨʀ ɤɿɧɰɿɜɤɢ Ʉɨɧɬɪɚɤɬɭɪɢ ɫɭɝɥɨɛɿɜ, ɳɨ ɜɢɡɧɚɱɚɽɬɶɫɹ ɩɪɢ ɮɿɡɢɤɚɥɶɧɨɦɭ ɨɛɫɬɟɠɟɧɧɿ
ɋɬɪɭɤɬɭɪɚ ɞɿɥɹɧɨɤ ɲɤɿɪɢ Pressure ulcer grading
ɋɬɪɭɤɬɭɪɢ ɦ’ɹɡɿɜ Ⱥɬɪɨɮɿɹ ɦ’ɹɡɿɜ, ɳɨ ɜɢɡɧɚɱɚɽɬɶɫɹ ɩɪɢ ɮɿɡɢɤɚɥɶɧɨɦɭ ɨɛɫɬɟɠɟɧɧɿ
Ɏɭɧɤɰɿʀ /ɋɬɪɭɤɬɭɪɢ ɨɪɝɚɧɿɡɦɭ / Ⱥɤɬɢɜɧɿɫɬɶ/ɍɱɚɫɬɶ
Ʉɨɦɛɿɧɨɜɚɧɿ ɧɟɜɪɨɥɨɝɿɱɧɿ ɮɭɧɤɰɿʀ National Institutes of Health Stroke Scale, Canadian Neurological Scale
Ⱥɤɬɢɜɧɿɫɬɶ ɬɚ ɍɱɚɫɬɶ
Ⱥɤɬɢɜɧɿɫɬɶ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ ȱɧɞɟɤɫ Ȼɚɪɬɟɥɹ, FIM
ȱɧɫɬɪɭɦɟɧɬɚɥɶɧɚ ɚɤɬɢɜɧɿɫɬɶ Frenchay Activities Index, Rivermead ADL Scale
ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ
Ɇɨɛɿɥɶɧɿɫɬɶ Berg Balance Scale, Rivermead Mobility Index, Timed Up and Go Test
ɋɩɪɢɬɧɿɫɬɶ Nine Hole Peg Test
Ɏɭɧɤɰɿɹ ɜɟɪɯɧɶɨʀ ɤɿɧɰɿɜɤɢ Motor Activity Log, ABILHAND
Ⱥɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ Modified Rankin Scale, London Handicap Scale, WHODAS II, Impact on Participation
and Autonomy Questionnaire, Participation Profile, Participation Scale, Keele
Assessment of Participation
Ɏɚɤɬɨɪɢ ɫɟɪɟɞɨɜɢɳɚ
ɇɚɣɛɥɢɠɱɿ ɪɨɞɢɱɿ ɋɨɰɿɚɥɶɧɢɣ ɚɧɚɦɧɟɡ
ȼɢɪɨɛɢ ɬɚ ɬɟɯɧɨɥɨɝɿʀ ɞɥɹ ɨɫɨɛɢɫɬɨɝɨ Ɏɭɧɤɰɿɨɧɚɥɶɧɢɣ ɚɧɚɦɧɟɡ
ɤɨɪɢɫɬɭɜɚɧɧɹ ɜ ɩɨɜɫɹɤɞɟɧɧɨɦɭ ɠɢɬɬɿ
ɉɪɨɟɤɬɭɜɚɧɧɹ, ɛɭɞɿɜɧɢɰɬɜɨ ɬɚ ɋɨɰɿɚɥɶɧɢɣ ɚɧɚɦɧɟɡ
ɛɭɞɿɜɟɥɶɧɿ ɜɢɪɨɛɢ ɬɚ ɬɟɯɧɨɥɨɝɿʀ
ɛɭɞɿɜɟɥɶ ɨɫɨɛɢɫɬɨɝɨ ɤɨɪɢɫɬɭɜɚɧɧɹ
əɀ/ əɀ, ɩɨɜ’ɹɡɚɧɚ ɡɿ ɡɞɨɪɨɜ’ɹɦ
əɀ SF-36, NHP, EuroQoL, Stroke Impact Scale, Stroke Specific Quality of Life Scale,
Stroke Adapted Sickness Impact Profile
ÌÐÒ: Ìàãí³òíî-ðåçîíàíñíà òîìîãðàô³ÿ, ÊÒ: Êîìï’þòåðíà òîìîãðàô³ÿ, FIM: Functional Independence Measure; ÀÏÆ: Àêòèâ-
íîñò³ ïîâñÿêäåííîãî æèòòÿ; WHODAS II: World Health Organization Disability Assessment Schedule II (Ïðîòîêîë îö³íþâàííÿ
îáìåæåíü æèòòºä³ÿëüíîñò³ ÂÎÎÇ ²²); SF-36: Medical Outcomes Study Short Form 36 (Êîðîòêà ôîðìà äîñë³äæåííÿ ìåäè÷íèõ
ðåçóëüòàò³â 36); NHP: Nottingham Health Profile (Íîòòèíãåìñüêèé ïðîô³ëü çäîðîâ’ÿ)

138 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018

Äîäàòîê 3 – Îö³íþâàííÿ àêòèâíîñò³ òà ó÷àñò³ / ³íñòðóìåíòè âèì³ðþâàííÿ
ȱɧɫɬɪɭɦɟɧɬɢ
Activity & Participation
Questionnaire (APQ-6)
Activity Card Sort (ACS)
Assessment of Life Habits
(LIFE-H)
Australian Community
Participation Questionnaire
(ACPQ)
Child and Adolescent Scale of
Participation (CASP)
Community Integration
Questionnaire (CIQ)
Community Living Skills Scale
(CLSS)
Community Reintegration of
Service Members (CRIS)
Frenchay Activities Index (FAI)
ICF Measure of Participation &
ACTivities Screener (IMPACT-
S)
Impact on Participation and
Autonomy Questionnaire
(IPAQ)
Keele Assessment of
Participation (KAP)
Late Life Function and
Disability Instrument (LLFDI) ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ, ɞɟ 81,9% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ
Maastricht Social Participation ȱɧɫɬɪɭɦɟɧɬ ɡ 26 ɩɭɧɤɬɿɜ, ɳɨ ɜɤɥɸɱɚɽ 4 ɫɭɛɲɤɚɥɢ (ɭɱɚɫɬɶ ɭ ɫɩɨɠɢɜɚɧɧɿ, Mars et al.67
Profile (MSPP)
Mayo-Portland Adaptability
Inventory-4 (MPAI-4)
Measurement of a Person’s
Habitual Physical Activity
(MPHPA)
Nordic Mobility-related
Participation Outcome
Evaluation of Assistive Device ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
Intervention (NOMO)
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß
Ɉɫɨɛɥɢɜɨɫɬɿ ɉɨɫɢɥɚɧɧɹ
ȱɧɫɬɪɭɦɟɧɬ ɡ 11 ɩɭɧɤɬɿɜ ɡ 6 ɨɫɧɨɜɧɢɦɢ ɩɢɬɚɧɧɹɦɢ, ɹɤɿ ɨɰɿɧɸɸɬɶ Stewart et al.54
ɧɚɜɱɚɥɶɧɭ, ɩɪɨɮɟɫɿɣɧɭ ɬɚ ɫɨɰɿɚɥɶɧɭ ɭɱɚɫɬɶ.
ȱɧɫɬɪɭɦɟɧɬ, ɳɨ ɨɰɿɧɸɽ ɭɱɚɫɬɶ ɨɫɨɛɢ ɜ ɩɨɛɭɬɨɜɿɣ, ɞɨɡɜɿɥɶɧɿɣ ɬɚ Baum et al.55
ɫɨɰɿɚɥɶɧɿɣ ɚɤɬɢɜɧɨɫɬɿ (ɧɚɩɪ. ɩɪɢɛɢɪɚɧɧɹ, ɡɞɿɣɫɧɟɧɧɹ ɩɨɤɭɩɨɤ,
ɤɟɪɭɜɚɧɧɹ ɬɪɚɧɫɩɨɪɬɧɢɦ ɡɚɫɨɛɨɦ).
ȱɧɫɬɪɭɦɟɧɬ ɡ 77 ɩɭɧɤɬɿɜ ɡ 12 ɞɨɦɟɧɚɦɢ, 6 ɡ ɹɤɢɯ ɨɯɨɩɥɸɸɬɶ ɫɨɰɿɚɥɶɧɿ Fougeyrollas et al.56
ɪɨɥɿ (ɨɛɨɜ’ɹɡɤɢ, ɦɿɠɨɫɨɛɢɫɬɿɫɧɿ ɜɿɞɧɨɫɢɧɢ, ɫɭɫɩɿɥɶɧɟ ɠɢɬɬɹ, ɧɚɜɱɚɧɧɹ,
ɪɨɛɨɬɚ ɿ ɜɿɞɩɨɱɢɧɨɤ) ɬɚ ɿɧɲɿ, ɹɤɿ ɨɯɨɩɥɸɸɬɶ ɤɨɦɭɧɿɤɚɰɿɸ, ɯɚɪɱɭɜɚɧɧɹ,
ɨɫɨɛɢɫɬɭ ɝɿɝɿɽɧɭ, ɩɟɪɟɫɭɜɚɧɧɹ, ɮɿɡɢɱɧɭ ɩɿɞɝɨɬɨɜɤɭ ɿ ɠɢɬɥɨ, ɞɟ 92,7%
ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 30 ɩɭɧɤɬɿɜ ɡ 14 ɞɨɦɟɧɚɦɢ (ɤɨɧɬɚɤɬ ɡ ɧɚɣɛɥɢɠɱɢɦɢ ɬɚ Berry et al.57
ɞɚɥɟɤɢɦɢ ɪɨɞɢɱɚɦɢ, ɞɪɭɡɹɦɢ, ɫɭɫɿɞɚɦɢ ɿ ɫɩɿɜɩɪɚɰɿɜɧɢɤɚɦɢ, ɧɚɜɱɚɧɧɹ,
ɪɟɥɿɝɿɹ, ɨɪɝɚɧɿɡɨɜɚɧɟ ɫɭɫɩɿɥɶɫɬɜɨ, ɜɨɥɨɧɬɟɪɫɶɤɚ ɬɚ ɛɥɚɝɨɞɿɣɧɚ
ɚɤɬɢɜɧɿɫɬɶ, ɿɧɬɟɪɟɫ ɞɨ ɩɨɬɨɱɧɢɯ ɫɩɪɚɜ, ɩɭɛɥɿɱɧɟ ɜɢɫɥɨɜɥɟɧɧɹ ɞɭɦɨɤ,
ɚɤɬɢɜɧɿɫɬɶ ɭ ɫɩɿɥɶɧɨɬɿ, ɿ ɩɨɥɿɬɢɱɧɢɣ ɩɪɨɬɟɫɬ, ɞɟ 97,6% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ
ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ɒɤɚɥɚ ɡ 20 ɩɭɧɤɬɿɜ, ɹɤɚ ɨɰɿɧɸɽ ɫɨɰɿɚɥɶɧɭ ɭɱɚɫɬɶ (ɧɚɣɛɥɢɠɱɟ Bedell58
ɫɟɪɟɞɨɜɢɳɟ, ɲɤɨɥɚ ɬɚ ɝɪɨɦɚɞɚ) ɞɿɬɟɣ ɜɿɤɨɦ ɛɿɥɶɲ 3 ɪɨɤɿɜ ɬɚ ɩɿɞɥɿɬɤɿɜ
ɡ ɱɟɪɟɩɧɨ-ɦɨɡɤɨɜɨɸ ɬɪɚɜɦɨɸ.
ȱɧɫɬɪɭɦɟɧɬ ɡ 15 ɩɭɧɤɬɿɜ ɡ 3 ɫɭɛɲɤɚɥɚɦɢ, ɳɨ ɜɤɥɸɱɚɸɬɶ ɿɧɬɟɝɪɚɰɿɸ Willer et al.59
ɜɞɨɦɚ, ɫɨɰɿɚɥɶɧɭ ɿɧɬɟɝɪɚɰɿɸ ɬɚ ɩɪɨɞɭɤɬɢɜɧɭ ɚɤɬɢɜɧɿɫɬɶ (ɲɤɨɥɚ, ɪɨɛɨɬɚ
ɚɛɨ ɜɨɥɨɧɬɟɪɫɶɤɚ ɚɤɬɢɜɧɿɫɬɶ) ɩɨɫɬɪɚɠɞɚɥɢɯ ɜɿɞ ɱɟɪɟɩɧɨ-ɦɨɡɤɨɜɨʀ
ɬɪɚɜɦɢ.
ɒɤɚɥɚ ɡ 57 ɩɭɧɤɬɿɜ, ɳɨ ɨɰɿɧɸɽ ɮɭɧɤɰɿɨɧɚɥɶɧɿ ɜɥɚɫɬɢɜɨɫɬɿ ɥɸɞɟɣ ɡ Smith et al.60
ɯɪɨɧɿɱɧɢɦɢ ɩɫɢɯɿɱɧɢɦɢ ɡɚɯɜɨɪɸɜɚɧɧɹɦɢ ɭ ɫɩɿɥɶɧɨɬɿ.
ȱɧɫɬɪɭɦɟɧɬ ɡ 28 ɩɭɧɤɬɿɜ, ɳɨ ɨɰɿɧɸɽ ɫɬɭɩɿɧɶ, ɨɛɦɟɠɟɧɧɹ ɬɚ ɡɚɞɨɜɨɥɟɧɧɹ Resnik et al.61
ɜɿɞ ɭɱɚɫɬɿ, ɞɟ 83,1% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ
ɬɚ ɭɱɚɫɬɶ», ɚ ɬɚɤɨɠ ɽ ɞɟɹɤɿ ɩɭɧɤɬɢ, ɳɨ ɫɬɨɫɭɸɬɶɫɹ ɮɚɤɬɨɪɿɜ ɫɟɪɟɞɨɜɢɳɚ.
ȱɧɫɬɪɭɦɟɧɬ ɡ 15 ɩɭɧɤɬɿɜ ɡ 3 ɫɭɛɲɤɚɥɚɦɢ (ɪɨɛɨɬɚ/ɞɨɡɜɿɥɥɹ, ɚɤɬɢɜɧɨɫɬɿ Holbrook et al.62
ɜɞɨɦɚ ɬɚ ɧɚ ɜɿɞɤɪɢɬɨɦɭ ɩɨɜɿɬɪɿ), ɳɨ ɨɯɨɩɥɸɽ 100% ɤɨɦɩɨɧɟɧɬɭ ɆɄɎ
«ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 33 ɩɭɧɤɬɿɜ ɧɚ ɛɚɡɿ ɆɄɎ, ɹɤɢɣ ɨɯɨɩɥɸɽ ɜɫɿ 9 ɪɨɡɞɿɥɿɜ Post et al.63
ɤɨɦɩɨɧɟɧɬɭ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 41 ɩɭɧɤɬɿɜ ɡ 5 ɫɭɛɲɤɚɥɚɦɢ (Ⱥɜɬɨɧɨɦɧɿɫɬɶ ɜ ɩɪɢɦɿɳɟɧɧɿ, Cardol et al.64
Ⱥɜɬɨɧɨɦɧɿɫɬɶ ɧɚ ɜɿɞɤɪɢɬɨɦɭ ɩɨɜɿɬɪɿ, Ɋɨɥɶ ɜ ɫɿɦ'ʀ, ȼɡɚɽɦɢɧɢ ɿ ɫɨɰɿɚɥɶɧɟ
ɠɢɬɬɹ ɬɚ Ɉɫɜɿɬɚ ɿ ɪɨɛɨɬɚ), ɳɨ ɨɰɿɧɸɽ ɫɩɪɢɣɧɹɬɬɹ ɨɛɦɟɠɟɧɶ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɿ ɚɜɬɨɧɨɦɿʀ, ɞɟ 94,3% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ
ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ» ɩɨɪɹɞ ɡ ɞɟɹɤɢɦɢ ɩɭɧɤɬɚɦɢ, ɳɨ ɜɿɞɧɨɫɹɬɶɫɹ
ɞɨ ɮɚɤɬɨɪɿɜ ɫɟɪɟɞɨɜɢɳɚ.
ȱɧɫɬɪɭɦɟɧɬ ɡ 11 ɩɭɧɤɬɿɜ, ɳɨ ɨɰɿɧɸɽ ɡɞɚɬɧɿɫɬɶ ɩɟɪɟɦɿɳɟɧɧɹ, Wilkie et al.65
ɫɚɦɨɨɛɫɥɭɝɨɜɭɜɚɧɧɹ, ɚɤɬɢɜɧɨɫɬɿ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ, ɨɫɜɿɬɭ
ɿ ɫɨɰɿɚɥɶɧɭ ɚɤɬɢɜɧɿɫɬɶ, ɞɟ 92% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ
«ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 48 ɩɭɧɤɬɿɜ, ɳɨ ɩɨɤɪɢɜɚɽ ɞɨɦɟɧɢ ɮɭɧɤɰɿɣ ɬɚ ɨɛɦɟɠɟɧɶ Haley et al.66
«ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ɮɨɪɦɚɥɶɧɚ, ɧɟɮɨɪɦɚɥɶɧɚ ɫɨɰɿɚɥɶɧɚ ɭɱɚɫɬɶ, ɳɨ ɜɿɞɧɨɫɢɬɶɫɹ ɞɨ ɪɨɞɢɧɢ ɬɚ
ɡɧɚɣɨɦɢɯ), ɞɟ 88,6% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ
ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 37 ɩɭɧɤɬɿɜ, ɳɨ ɨɰɿɧɸɽ ɡɞɚɬɧɿɫɬɶ, ɩɪɢɫɬɨɫɭɜɚɧɧɹ ɿ ɭɱɚɫɬɶ, Malec et al.68
ɞɟ ɬɿɥɶɤɢ 46,9% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ
ɭɱɚɫɬɶ»; ɨɞɧɚɤ, ɡ ɞɟɹɤɢɦɢ ɩɭɧɤɬɚɦɢ, ɳɨ ɜɿɞɧɨɫɹɬɶɫɹ ɞɨ ɮɚɤɬɨɪɿɜ
ɫɟɪɟɞɨɜɢɳɚ ɬɚ ɨɫɨɛɢɫɬɢɯ ɮɚɤɬɨɪɿɜ.
ȱɧɫɬɪɭɦɟɧɬ ɡ 22 ɩɭɧɤɬɿɜ ɡ 3 ɫɭɛɲɤɚɥɚɦɢ (ɚɤɬɢɜɧɨɫɬɿ ɪɨɛɨɬɢ, ɫɩɨɪɬɭ ɬɚ Baecke et al.69
ɞɨɡɜɿɥɥɹ), ɞɟ 90,9% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ
ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 28 ɩɭɧɤɬɿɜ, ɹɤɢɣ ɨɰɿɧɸɽ ɦɨɛɿɥɶɧɿɫɬɶ ɭ ɡɜ’ɹɡɤɭ ɿɡ Brandt et al.70
ɡɚɥɟɠɧɿɫɬɸ, ɞɨɩɨɦɨɝɨɸ, ɱɚɫɬɨɬɨɸ, ɫɤɥɚɞɧɿɫɬɸ ɿ ɭɱɚɫɬɸ, ɞɟ 84,4%
139
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Norwegian Function
Assessment Scale (NFAS)
Participation and Environment
Measure for Children and Youth
(PEM-CY)
Participation Assessment With
Recombined Tools-Objective
(PART-O)
Participation Enfranchisement
(PE)
Participation Measure for Post-
Acute Care (PM-PAC)
Participation Objective,
Participation Subjective (POPS)
Participation Scale/P-scale
Participation Survey/Mobility
(PARTS/M)
Pepper Assessment Tool for
Disability (PAT-D)
Perceived Impact of Problem
Profile (PIP)
Psychosocial Adjustment to
Illness Scale (PAIS)
Rating of Perceived
Participation (ROPP)
Rehabilitation Activities Profile
(RAP)
Social-Functional Autonomy
Measurement System (Social
SMAF)
Social Participation
Questionnaire (SPQ)
Socially Valued Role
Classification Scale (SRCS)
Stroke Impact Scale (SIS)
Sydney Psychosocial
Reintegration Scale Version 2
(SPRS-2)
140 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ïðîäîâæåííÿ äîäàòêà 3Â
ȱɧɫɬɪɭɦɟɧɬ ɡ 39 ɩɭɧɤɬɿɜ, ɳɨ ɨɯɨɩɥɸɽ 7 ɞɨɦɟɧɿɜ (ɫɬɨɹɧɧɹ/ɯɨɞɶɛɚ, Bushnik71
ɡɛɢɪɚɧɧɹ/ɭɬɪɢɦɚɧɧɹ, ɩɿɞɣɨɦ/ɩɟɪɟɧɟɫɟɧɧɹ, ɫɢɞɿɧɧɹ, ɭɩɪɚɜɥɿɧɧɹ,
ɤɨɦɭɧɿɤɚɰɿɹ/ɫɩɿɜɪɨɛɿɬɧɢɰɬɜɨ ɿ ɩɨɱɭɬɬɹ, ɞɟ 97,7% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ
ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ, ɳɨ ɨɰɿɧɸɽ ɭɱɚɫɬɶ ɬɚ ɮɚɤɬɨɪɢ ɫɟɪɟɞɨɜɢɳɚ ɭ ɞɿɬɟɣ ɬɚ Coster et al.72
ɩɿɞɥɿɬɤɿɜ ɭ ɜɿɰɿ ɜɿɞ 5 ɞɨ 17 ɪɨɤɿɜ ɡ ɨɛɦɟɠɟɧɧɹɦ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ ɚɛɨ ɛɟɡ
ɧɟʀ.
ȱɧɫɬɪɭɦɟɧɬ ɡ 17 ɩɭɧɤɬɿɜ, ɳɨ ɜɤɥɸɱɚɽ ɜ ɫɟɛɟ 3 ɫɭɛɲɤɚɥɢ, ɳɨ ɜɿɞɧɨɫɹɬɶɫɹ Whiteneck et al.73
ɞɨ ɩɪɨɞɭɤɬɢɜɧɨɫɬɿ, ɫɨɰɿɚɥɶɧɢɯ ɜɿɞɧɨɫɢɧ ɿ ɡɚɯɨɞɚɦ ɧɚ ɜɿɞɤɪɢɬɨɦɭ
ɩɨɜɿɬɪɿ, ɩɟɪɜɢɧɧɨ ɪɨɡɪɨɛɥɟɧɢɣ ɞɥɹ ɨɫɿɛ ɡ ɱɟɪɟɩɧɨ-ɦɨɡɤɨɜɨɸ ɬɪɚɜɦɨɸ,
ɞɟ 89,7% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
Ɉɩɢɬɭɜɚɥɶɧɢɤ, ɳɨ ɫɤɥɚɞɚɽɬɶɫɹ ɡ 19 ɩɭɧɤɬɿɜ, ɹɤɢɣ ɨɰɿɧɸɽ ɩɟɪɟɫɭɜɚɧɧɹ, Heinemann et al.74
ɫɭɫɩɿɥɶɧɭ ɚɤɬɢɜɧɿɫɬɶ, ɜɪɚɯɨɜɭɸɱɢ ɡɞɚɬɧɿɫɬɶ ɪɨɛɢɬɢ ɜɢɛɿɪ, ɨɱɿɤɭɜɚɧɧɹ,
ɨɛɨɜ’ɹɡɤɢ ɿ ɰɿɧɧɨɫɬɿ, ɞɟ 85,7% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ
«ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 51 ɩɭɧɤɬɿɜ ɿɡ 9 ɞɨɦɟɧɚɦɢ (Ɇɨɛɿɥɶɧɿɫɬɶ, Ɋɨɥɶɨɜɿ ɮɭɧɤɰɿʀ, Gandek et al.75
Ⱦɨɦɚɲɧɽ ɠɢɬɬɹ/ɫɚɦɨɨɛɫɥɭɝɨɜɭɜɚɧɧɹ, Ɇɿɠɨɫɨɛɢɫɬɿɫɧɿ ɜɿɞɧɨɫɢɧɢ,
Ƚɪɨɦɚɞɚ, ɋɨɰɿɚɥɶɧɟ ɬɚ ɰɢɜɿɥɶɧɟ ɠɢɬɬɹ, Ɉɫɧɨɜɧɿ ɫɮɟɪɢ ɠɢɬɬɹ,
Ʉɨɦɭɧɿɤɚɰɿɹ, Ɉɫɜɿɬɚ ɬɚ ɪɨɛɨɬɚ), ɞɟ 91,5% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ
ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 26 ɩɭɧɤɬɚɦɢ ɧɚ ɨɫɧɨɜɿ ɆɄɎ, ɳɨ ɫɤɥɚɞɚɽɬɶɫɹ ɡ 5 ɫɭɛɲɤɚɥ Brown et al.76
(ɞɨɦɚɲɧɽ ɠɢɬɬɹ, ɦɿɠɨɫɨɛɢɫɬɿɫɧɿ ɜɡɚɽɦɨɞɿʀ ɬɚ ɜɿɞɧɨɫɢɧɢ, ɨɫɧɨɜɧɿ ɫɮɟɪɢ
ɠɢɬɬɹ, ɬɪɚɧɫɩɨɪɬ, ɝɪɨɦɚɞɚ, ɜɿɞɩɨɱɢɧɤɨɜɟ ɬɚ ɰɢɜɿɥɶɧɟ ɠɢɬɬɹ), ɳɨ
ɩɨɤɪɢɜɚɽ 100% ɤɨɦɩɨɧɟɧɬɭ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 18 ɩɭɧɤɬɚɦɢ, ɳɨ ɨɰɿɧɸɽ ɫɨɰɿɚɥɶɧɭ ɭɱɚɫɬɿ, ɞɟ 88,9% ɩɭɧɤɬɿɜ Van Brakel et al.77
ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 161 ɩɭɧɤɬɚɦɢ, ɳɨ ɜɤɥɸɱɚɽ 6 ɞɨɦɟɧɿɜ (ɋɚɦɨɨɛɫɥɭɝɨɜɭɜɚɧɧɹ, Gray et al.78
Ɇɨɛɿɥɶɧɿɫɬɶ, Ⱦɨɦɚɲɧɽ ɠɢɬɬɹ, Ɇɿɠɨɫɨɛɢɫɬɿɫɧɿ ɜɡɚɽɦɨɞɿʀ ɬɚ ɜɿɞɧɨɫɢɧɢ,
Ɉɫɧɨɜɧɿ ɫɮɟɪɢ ɠɢɬɬɹ ɬɚ Ƚɪɨɦɚɞɫɶɤɟ, ɫɨɰɿɚɥɶɧɟ ɬɚ ɰɢɜɿɥɶɧɟ ɠɢɬɬɹ), ɞɟ
82,7% ɟɥɟɦɟɧɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 19 ɩɭɧɤɬɚɦɢ ɡ 3 ɫɭɛɲɤɚɥɚɦɢ (ɨɫɧɨɜɧɿ ɬɚ ɿɧɫɬɪɭɦɟɧɬɚɥɶɧɿ Rejeski et al.79
ɚɤɬɢɜɧɨɫɬɿ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ ɬɚ ɦɨɛɿɥɶɧɿɫɬɶ), ɹɤɢɣ ɨɯɨɩɥɸɽ 100%
ɤɨɦɩɨɧɟɧɬɭ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 23 ɩɭɧɤɬɚɦɢ, ɹɤɢɣ ɜɤɥɸɱɚɽ 5 ɞɨɦɟɧɿɜ (ɫɚɦɨ ɨɛɫɥɭɝɨ- Pallant et al.80
ɜɭɜɚɧɧɹ, ɦɨɛɿɥɶɧɿɫɬɶ, ɜɡɚɽɦɨɡɜ’ɹɡɨɤ, ɭɱɚɫɬɶ ɬɚ ɩɫɢɯɨɥɨɝɿɱɧɟ ɛɥɚɝɨ-
ɩɨɥɭɱɱɹ), ɳɨ ɫɬɚɧɨɜɢɬɶ 80,6% ɩɨɡɢɰɿɣ, ɩɨɜ’ɹɡɚɧɢɯ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ
«ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 46 ɩɭɧɤɬɚɦɢ ɬɚ 7 ɞɨɦɟɧɚɦɢ (ɨɯɨɪɨɧɚ ɡɞɨɪɨɜ'ɹ, ɩɪɨɮɟɫɿɣɧɚ Derogatis81
ɚɤɬɢɜɧɿɫɬɶ, ɞɨɦɚɲɧɽ ɠɢɬɬɹ, ɫɬɨɫɭɧɤɢ – ɧɚɣɛɥɢɠɱɿ ɬɚ ɞɚɥɶɧɿ ɪɨɞɢɱɢ,
ɫɨɰɿɚɥɶɧɟ ɫɟɪɟɞɨɜɢɳɟ ɿ ɩɫɢɯɨɥɨɝɿɱɧɢɣ ɞɢɫɤɨɦɮɨɪɬ), ɪɨɡɪɨɛɥɟɧɢɣ ɞɥɹ
ɨɫɿɛ ɡ ɯɪɨɧɿɱɧɢɦɢ ɫɬɚɧɚɦɢ ɡɞɨɪɨɜ'ɹ
ȱɧɫɬɪɭɦɟɧɬ ɡ 16 ɩɭɧɤɬɚɦɢ, ɹɤɢɣ ɨɯɨɩɥɸɽ 100% ɤɨɦɩɨɧɟɧɬɭ ɆɄɎ Sandström et al.82
«ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 71 ɩɭɧɤɬɚɦɢ, ɳɨ ɜɤɥɸɱɚɽ 5 ɞɨɦɟɧɿɜ (ɤɨɦɭɧɿɤɚɰɿɹ, Jelles et al.83
ɦɨɛɿɥɶɧɿɫɬɶ, ɫɚɦɨɨɛɫɥɭɝɨɜɭɜɚɧɧɹ, ɡɚɧɹɬɬɹ ɬɚ ɜɿɞɧɨɫɢɧɢ), ɞɟ 93,8%
ɟɥɟɦɟɧɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
ȱɧɫɬɪɭɦɟɧɬ ɡ 35 ɩɭɧɤɬɚɦɢ, ɳɨ ɨɰɿɧɸɽ ɩɫɢɯɿɱɧɿ ɮɭɧɤɰɿʀ, ɤɨɦɭɧɿɤɚɰɿɸ, Pinsonnault et al.84
ɦɨɛɿɥɶɧɿɫɬɶ, ɨɫɧɨɜɧɿ ɬɚ ɿɧɫɬɪɭɦɟɧɬɚɥɶɧɿ ɚɤɬɢɜɧɨɫɬɿ ɩɨɜɫɹɤɞɟɧɧɨɝɨ
ɠɢɬɬɹ ɬɚ ɫɨɰɿɚɥɶɧɟ ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ, ɞɟ 80,5% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɡ
ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
Ɉɩɢɬɭɜɚɥɶɧɢɤ ɡ 22 ɩɭɧɤɬɿɜ, ɳɨ ɨɰɿɧɸɽ ɫɨɰɿɚɥɶɧɿ ɜɿɞɧɨɫɢɧɢ ɬɚ ɡɚɥɭɱɟɧɧɹ Densley et al.85
ɞɨ ɫɨɰɿɚɥɶɧɨʀ ɚɤɬɢɜɧɨɫɬɿ, ɞɟ 90,3% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ ɿɡ ɤɨɦɩɨɧɟɧɬɨɦ
ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ»
ȱɧɫɬɪɭɦɟɧɬ ɡ 25 ɩɭɧɤɬɿɜ, ɳɨ ɫɤɥɚɞɚɽɬɶɫɹ ɡ 5 ɞɨɦɟɧɿɜ (ɞɨɦɚɲɧɿ ɡɚɜɞɚɧɧɹ ɿ Harris at al.86
ɫɚɦɨɨɛɫɥɭɝɨɜɭɜɚɧɧɹ, ɨɫɨɛɢɫɬɢɣ ɪɨɡɜɢɬɨɤ ɿ ɪɟɚɛɿɥɿɬɚɰɿɹ, ɞɨɝɥɹɞ ɡɚ
ɿɧɲɢɦɢ, ɮɨɪɦɚɥɶɧɚ ɨɫɜɿɬɚ ɿ ɧɚɜɱɚɧɧɹ, ɚ ɬɚɤɨɠ ɪɨɛɨɬɚ), ɞɟ 85,7% ɩɭɧɤɬɿɜ
ɩɨ’ɜɹɡɚɧɿ ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ»
ȱɧɫɬɪɭɦɟɧɬ ɡ 64 ɩɭɧɤɬɿɜ, ɪɨɡɪɨɛɥɟɧɢɣ ɞɥɹ ɩɚɰɿɽɧɬɿɜ ɡ ɿɧɫɭɥɶɬɨɦ, ɹɤɢɣ Duncan et al.87
ɨɯɨɩɥɸɽ 8 ɞɨɦɟɧɿɜ (ɫɢɥɚ, ɮɭɧɤɰɿɹ ɤɿɫɬɿ, ɤɨɦɭɧɿɤɚɰɿɹ, ɩɚɦ’ɹɬɶ, ɟɦɨɰɿʀ,
ɦɿɪɤɭɜɚɧɧɹ, ɚɤɬɢɜɧɨɫɬɿ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ ɬɚ ɭɱɚɫɬɶ).
ȱɧɫɬɪɭɦɟɧɬ ɡ 12 ɩɭɧɤɬɿɜ, ɳɨ ɫɤɥɚɞɚɽɬɶɫɹ ɡ 3 ɞɨɦɟɧɿɜ (ɪɨɛɨɬɚ/ɞɨɡɜɿɥɥɹ, Tate et al.88
ɦɿɠɨɫɨɛɢɫɬɿɫɧɿ ɜɿɞɧɨɫɢɧɢ ɬɚ ɧɚɜɢɱɤɢ ɧɟɡɚɥɟɠɧɨɝɨ ɠɢɬɬɹ), ɫɩɨɱɚɬɤɭ
ɪɨɡɪɨɛɥɟɧɢɣ ɞɥɹ ɱɟɪɟɩɧɨ-ɦɨɡɤɨɜɨʀ ɬɪɚɜɦɢ, ɞɟ 96,2% ɟɥɟɦɟɧɬɿɜ ɩɨ’ɜɹɡɚɧɿ
ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
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 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Ïðîäîâæåííÿ äîäàòêà 3Â

Time Organisation and ȱɧɫɬɪɭɦɟɧɬ ɡ 32 ɩɭɧɤɬɿɜ ɡ 3 ɫɭɛɲɤɚɥɚɦɢ (ɜɢɤɨɧɚɧɧɹ ɳɨɞɟɧɧɢɯ ɡɚɜɞɚɧɶ, Rosenblum89
Participation Scale (TOPS) ɨɪɝɚɧɿɡɚɰɿɹ ɚɤɬɢɜɧɨɫɬɿ ɬɚ ɟɦɨɰɿɣɧɿ ɜɿɞɩɨɜɿɞɿ), ɞɟ 86,7% ɩɭɧɤɬɿɜ ɩɨ’ɜɹɡɚɧɿ
ɡ ɤɨɦɩɨɧɟɧɬɨɦ ɆɄɎ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ ɭɱɚɫɬɶ».
Utrecht Scale for Evaluation of ȱɧɫɬɪɭɦɟɧɬ ɡ 32 ɩɭɧɤɬɿɜ, ɹɤɢɣ ɨɯɨɩɥɸɽ 100% ɤɨɦɩɨɧɟɧɬɭ «ɚɤɬɢɜɧɿɫɬɶ ɬɚ Post et al.90
Rehabilitation-Participation ɭɱɚɫɬɶ» ɆɄɎ ɿ ɨɰɿɧɸɽ ɡɚ ɞɨɩɨɦɨɝɨɸ ɪɟɣɬɢɧɝɨɜɢɯ ɲɤɚɥ ɱɚɫɬɨɬɭ,
(USER-Participation) ɨɛɦɟɠɟɧɧɹ ɿ ɡɚɞɨɜɨɥɟɧɧɹ.
WHO Disability Assessment ȱɧɫɬɪɭɦɟɧɬ ɰɿɥɤɨɦ ɧɚ ɨɫɧɨɜɿ ɆɄɎ ɡ 36 ɩɭɧɤɬɚɦɢ ɭ 6 ɞɨɦɟɧɚɯ Üstün et al.91
Schedule 2.0 (WHODAS 2.0) (ɪɨɡɭɦɿɧɧɹ ɬɚ ɫɩɿɥɤɭɜɚɧɧɹ, ɩɟɪɟɫɭɜɚɧɧɹ, ɫɚɦɨɨɛɫɥɭɝɨɜɭɜɚɧɧɹ, ɜɡɚɽɦɨɞɿɹ
ɡ ɿɧɲɢɦɢ, ɚɤɬɢɜɧɨɫɬɿ ɠɢɬɬɹ ɬɚ ɭɱɚɫɬɶ ɭ ɫɭɫɩɿɥɶɫɬɜɿ.
ɇɟɳɨɞɚɜɧɨ ɪɨɡɪɨɛɥɟɧɿ ɿɧɫɬɪɭɦɟɧɬɢ
Oxford Participation and ȱɧɫɬɪɭɦɟɧɬ ɡ 23 ɩɭɧɤɬɿɜ ɧɚ ɛɚɡɿ ɆɄɎ ɡ 3 ɞɨɦɟɧɚɦɢ, ɳɨ ɨɰɿɧɸɸɬɶ Kelly et al.92
Activities Questionnaire (Ox- ɪɭɬɢɧɧɭ ɚɤɬɢɜɧɿɫɬɶ, ɟɦɨɰɿɣɧɟ ɛɥɚɝɨɩɨɥɭɱɱɹ ɬɚ ɫɨɰɿɚɥɶɧɟ ɡɚɥɭɱɟɧɧɹ. Morley et al.93
PAQ)
Ghent Participation Scale ȱɧɫɬɪɭɦɟɧɬ ɧɚ ɛɚɡɿ ɆɄɎ, ɳɨ ɜɤɥɸɱɚɽ 15 ɫɭɛ’ɽɤɬɢɜɧɢɯ ɤɨɦɩɨɧɟɧɬɿɜ, ɳɨ Van de Velde et al.94
(GPS). ɦɚɸɬɶ ɜɿɞɧɨɲɟɧɧɹ ɞɨ ɚɤɬɢɜɧɨɫɬɿ, ɹɤɚ ɽ ɜɚɠɥɢɜɨɸ ɞɥɹ ɨɫɨɛɢ ɬɚ
2 ɨɛ’ɽɤɬɢɜɧɢɯ ɤɨɦɩɨɧɟɧɬɢ, ɳɨ ɫɬɨɫɭɸɬɶɫɹ ɨɛɦɟɠɟɧɶ ɚɤɬɢɜɧɨɫɬɿ.
Ⱦɠɟɪɟɥɨ ɞɥɹ ɜɿɞɫɨɬɤɨɜɢɯ ɡɧɚɱɟɧɶ ɨɯɨɩɥɟɧɧɹ ɜɦɿɫɬɭ ɫɬɨɫɨɜɧɨ ɆɄɎ: Ballert et al.95.

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Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Äîäàòîê 4À – Âòðó÷àííÿ â ÔÐÌ

Ɇɟɞɢɱɧɿ ɜɬɪɭɱɚɧɧɹ Ɇɟɞɢɤɚɦɟɧɬɨɡɧɟ ɥɿɤɭɜɚɧɧɹ, ɫɩɪɹɦɨɜɚɧɟ ɧɚ ɜɿɞɧɨɜɥɟɧɧɹ ɚɛɨ ɩɨɥɿɩɲɟɧɧɹ ɫɬɪɭɤɬɭɪ ɬɚ/ɚɛɨ
ɮɭɧɤɰɿɣ ɨɪɝɚɧɿɡɦɭ, ɧɚɩɪ. ɡɧɟɛɨɥɸɜɚɥɶɧɚ ɬɟɪɚɩɿɹ, ɩɪɨɬɢɡɚɩɚɥɶɧɚ ɬɟɪɚɩɿɹ, ɪɟɝɭɥɹɰɿɹ
ɦ’ɹɡɨɜɨɝɨ ɬɨɧɭɫɭ, ɩɨɥɿɩɲɟɧɧɹ ɩɿɡɧɚɜɚɥɶɧɢɯ ɮɭɧɤɰɿɣ, ɩɨɥɿɩɲɟɧɧɹ ɮɿɡɢɱɧɨɝɨ
ɮɭɧɤɰɿɨɧɭɜɚɧɧɹ, ɩɨɥɿɩɲɟɧɧɹ ɡɞɨɪɨɜ'ɹ ɤɿɫɬɨɤ, ɥɿɤɭɜɚɧɧɹ ɞɟɩɪɟɫɿʀ ɚɛɨ ɪɨɡɥɚɞɿɜ ɧɚɫɬɪɨɸ,
ɥɿɤɭɜɚɧɧɹ ɪɨɡɥɚɞɿɜ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ, ɤɢɲɤɿɜɧɢɤɚ, ɚɛɨ ɫɟɤɫɭɚɥɶɧɨʀ ɞɢɫɮɭɧɤɰɿʀ, ɚɛɨ ɿɧɲɢɯ
ɧɚɫɥɿɞɤɿɜ ɚɛɨ ɭɫɤɥɚɞɧɟɧɶ ɧɟɜɪɨɥɨɝɿɱɧɢɯ ɫɬɚɧɿɜ, ɳɨ ɩɪɢɡɜɨɞɹɬɶ ɞɨ ɨɛɦɟɠɟɧɶ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ
(ɧɚɩɪ. ɝɟɬɟɪɨɬɨɩɧɚ ɨɫɿɮɿɤɚɰɿɹ, ɜɟɝɟɬɚɬɢɜɧɚ ɞɢɡɪɟɮɥɟɤɫɿɹ, ɨɪɬɨɫɬɚɬɢɱɧɚ ɝɿɩɨɬɟɧɡɿɹ)
ɉɪɚɤɬɢɱɧɿ ɩɪɨɰɟɞɭɪɢ, ɜɤɥɸɱɚɸɱɢ ɿɧ'ɽɤɰɿʀ (ɧɚɩɪ. ɚɧɟɫɬɟɬɢɤɿɜ, ɤɨɪɬɢɤɨɫɬɟɪɨʀɞɿɜ,
ɜɧɭɬɪɿɲɧɶɨɫɭɝɥɨɛɨɜɿ ɿɧ’ɽɤɰɿʀ ɝɿɚɥɭɪɨɧɨɜɨʀ ɤɢɫɥɨɬɢ, ɚɛɨ ɟɩɿɞɭɪɚɥɶɧɿ, ɚɛɨ ɿɧ’ɽɤɰɿʀ ɭ ɬɪɢɝɟɪɧɿ
ɬɨɱɤɢ), ɧɟɣɪɨɬɟɪɚɩɿɹ, ɪɟɝɟɧɟɪɚɬɢɜɧɚ ɿɧ'ɽɤɰɿɣɧɚ ɬɟɪɚɩɿɹ/ ɩɿɞɯɨɞɢ ɬɤɚɧɢɧɧɨʀ ɿɧɠɟɧɟɪɿʀ /
ɛɿɨɥɨɝɿɱɧɚ ɬɟɪɚɩɿɹ (ɧɚɩɪ. ɩɪɨɥɨɬɟɪɚɩɿɹ ɡ ɞɟɤɫɬɪɨɡɨɸ, ɩɥɚɡɦɚ, ɡɛɚɝɚɱɟɧɚ ɬɪɨɦɛɨɰɢɬɚɦɢ,
ɚɭɬɨɥɨɝɿɱɧɚ ɤɨɧɞɢɰɿɣɨɜɚɧɚ ɫɢɪɨɜɚɬɤɚ, ɚɭɬɨɥɨɝɿɱɧɢɣ ɛɿɥɤɨɜɢɣ ɪɨɡɱɢɧ, ɚɭɬɨɥɨɝɿɱɧɿ
ɦɟɡɟɧɯɿɦɚɥɶɧɿ ɚɛɨ ɿɧɲɿ ɫɬɨɜɛɭɪɨɜɿ ɤɥɿɬɢɧɢ), ɜɜɟɞɟɧɧɹ ɛɨɬɭɥɨɬɨɤɫɢɧɭ, ɨɡɨɧɨ-ɤɢɫɧɟɜɚ ɬɟɪɚɩɿɹ
/ ɿɧ’ɽɤɰɿʀ, ɛɥɨɤɚɞɢ ɧɟɪɜɿɜ ɬɚ ɿɧɲɿ ɦɟɬɨɞɢ ɜɜɟɞɟɧɧɹ ɥɿɤɚɪɫɶɤɢɯ ɡɚɫɨɛɿɜ (ɧɚɩɪ. ɿɨɧɨɮɨɪɟɡ,
ɮɨɧɨɮɨɪɟɡ, ɜɢɤɨɪɢɫɬɚɧɧɹ ɿɧɬɪɚɬɟɤɚɥɶɧɢɯ ɩɨɦɩ ɞɥɹ ɜɜɟɞɟɧɧɹ ɛɚɤɥɨɮɟɧɭ ɬɨɳɨ).
Ɉɰɿɧɸɜɚɧɧɹ ɬɚ ɚɧɚɥɿɡ ɪɟɡɭɥɶɬɚɬɿɜ ɜɬɪɭɱɚɧɶ, ɜɤɥɸɱɚɸɱɢ ɟɥɟɤɬɪɨɦɿɨɝɪɚɮɿɸ ɬɚ ɞɿɚɝɧɨɫɬɢɱɧɟ
ɭɥɶɬɪɚɡɜɭɤɨɜɟ ɞɨɫɥɿɞɠɟɧɧɹ
ɉɪɨɝɧɨɡɭɜɚɧɧɹ
ȼɬɪɭɱɚɧɧɹ ɎɊɆ ɡ ɮɿɡɢɱɧɢɦɢ Ʉɿɧɟɡɿɨɬɟɪɚɩɿɹ ɬɚ ɬɟɪɚɩɟɜɬɢɱɧɿ ɜɩɪɚɜɢ
ɚɝɟɧɬɚɦɢ ɬɚ ɬɟɪɚɩɟɜɬɢɱɧɢɦɢ Ɍɟɯɧɿɤɢ ɧɟɣɪɨɮɚɫɿɥɿɬɚɰɿʀ (ɧɚɩɪ. ɧɟɣɪɨɪɨɡɜɢɬɤɨɜɿ ɜɬɪɭɱɚɧɧɹ / ɩɿɞɯɨɞɢ Bobath, Brunnstrom,
ɜɩɪɚɜɚɦɢ ɬɟɯɧɿɤɚ Rood, ɩɪɨɩɪɿɨɰɟɩɬɢɜɧɚ ɧɟɣɪɨɦ’ɹɡɨɜɚ ɮɚɫɿɥɿɬɚɰɿɹ, ɬɟɪɚɩɿɹ ɡ ɫɟɧɫɨɪɧɨʀ ɿɧɬɟɝɪɚɰɿʀ,
Vojta-ɬɟɪɚɩɿɹ), ɚ ɬɚɤɨɠ ɩɪɚɤɬɢɤɚ ɩɨɜɬɨɪɸɜɚɧɢɯ ɡɚɜɞɚɧɶ (ɧɚɩɪ. ɬɟɪɚɩɿɹ ɩɪɢɦɭɫɨɜɢɦɢ ɪɭɯɚɦɢ)
ȼɿɛɪɚɰɿɣɧɚ ɬɟɪɚɩɿɹ, ɹɤ ɜɬɪɭɱɚɧɧɹ ɡɚ ɞɨɩɨɦɨɝɨɸ ɜɩɪɚɜ (ɧɚɩɪ., ɜɿɛɪɚɰɿɹ ɜɫɶɨɝɨ ɬɿɥɚ)
Ʉɨɦɩ’ɸɬɟɪɧɿ ɿɝɪɢ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɫɢɫɬɟɦ ɜɿɪɬɭɚɥɶɧɨʀ ɪɟɚɥɶɧɨɫɬɿ / ɿɝɪɨɜɢɯ ɤɨɧɫɨɥɟɣ /
ɜɿɞɟɨɿɝɨɪ
Ɇɟɞɢɬɚɬɢɜɧɿ ɪɭɯɨɜɿ ɬɟɪɚɩɿʀ (ɧɚɩɪ. ɰɢɝɭɧ, ɣɨɝɚ ɬɚ ɬɚɣ-ɱɢ)
Ɍɟɯɧɿɤɢ ɦɚɧɭɚɥɶɧɨʀ ɬɟɪɚɩɿʀ ɞɥɹ ɡɜɨɪɨɬɧɨ ɫɤɭɬɢɯ ɫɭɝɥɨɛɿɜ ɿ ɩɨɜ'ɹɡɚɧɢɯ ɞɢɫɮɭɧɤɰɿɣ ɦ’ɹɤɢɯ
ɬɤɚɧɢɧ, ɚ ɬɚɤɨɠ ɦɚɧɭɚɥɶɧɿ ɬɪɚɤɰɿʀ (ɦɨɠɥɢɜɿ ɬɚɤɨɠ ɬɪɚɤɰɿʀ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɩɪɢɫɬɪɨʀɜ)
Ɇɚɧɟɜɪɢ (ɧɚɩɪ. ɫɩɟɰɢɮɿɱɧɿ ɪɟɩɨɡɢɰɿɣɧɿ ɦɚɧɟɜɪɢ – Epley, Liberatory, Semont ɜ ɤɨɧɬɟɤɫɬɿ
ɪɟɚɛɿɥɿɬɚɰɿʀ ɜɟɫɬɢɛɭɥɹɪɧɢɯ ɪɨɡɥɚɞɿɜ / ɝɨɥɨɜɨɤɪɭɠɿɧɧɹ; ɮɿɡɢɱɧɿ ɤɨɧɬɪ-ɦɚɧɟɜɪɢ ɞɥɹ ɥɿɤɭɜɚɧɧɹ
ɨɪɬɨɫɬɚɬɢɱɧɨʀ ɝɿɩɨɬɟɧɡɿʀ)
Ⱦɢɯɚɥɶɧɚ ɮɿɡɢɱɧɚ ɬɟɪɚɩɿɹ – ɦɟɬɨɞɢ ɬɚ ɬɟɯɧɿɤɢ ɝɿɝɿɽɧɢ ɞɢɯɚɥɶɧɢɯ ɲɥɹɯɿɜ, ɿɧɝɚɥɹɰɿɣɧɚ ɬɟɪɚɩɿɹ,
ɞɢɯɚɥɶɧɿ ɜɩɪɚɜɢ
ȼɬɪɭɱɚɧɧɹ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɦɚɫɚɠɭ
ȿɥɟɤɬɪɨɬɟɪɚɩɿɹ (ɧɚɩɪ. ɦɟɬɨɞɢ ɟɥɟɤɬɪɨɫɬɢɦɭɥɹɰɿʀ – TENS, FES, NMES, ɫɬɢɦɭɥɹɰɿɹ ɫɩɢɧɧɨɝɨ
ɦɨɡɤɭ).
ɇɟɣɪɨɦɨɞɭɥɹɰɿɹ / ɧɟɿɧɜɚɡɢɜɧɿ ɦɟɬɨɞɢ ɫɬɢɦɭɥɹɰɿʀ ɦɨɡɤɭ (ɧɚɩɪ. tDCS, rTMS, CES, RINCE)
Ɇɚɝɧɿɬɨɬɟɪɚɩɿɹ (ɧɚɩɪ. PEMF ɞɥɹ ɩɨɥɟɝɲɟɧɧɹ ɛɨɥɸ, ɪɟɩɚɪɚɰɿʀ ɤɿɫɬɨɤ ɬɚ ɯɪɹɳɿɜ, ɡɚɝɨɸɜɚɧɧɹ
ɪɚɧ, ɜɢɤɨɪɢɫɬɚɧɧɹ ɦɚɝɧɿɬɧɢɯ ɫɬɿɥɶɰɿɜ ɭ ɤɨɧɬɟɤɫɬɿ ɭɪɨɝɿɧɟɤɨɥɨɝɿɱɧɨʀ ɪɟɚɛɿɥɿɬɚɰɿʀ)
ȱɧɲɿ ɦɟɬɨɞɢ ɮɿɡɢɱɧɨʀ ɬɟɪɚɩɿʀ, ɭ ɬɨɦɭ ɱɢɫɥɿ ɭɥɶɬɪɚɡɜɭɤɨɜɚ, ɟɤɫɬɪɚɤɨɪɩɨɪɚɥɶɧɚ ɭɞɚɪɧɨ-
ɯɜɢɥɶɨɜɚ ɬɟɪɚɩɿɹ, ɡɚɫɬɨɫɭɜɚɧɧɹ ɬɟɩɥɚ ɬɚ ɯɨɥɨɞɭ, ɤɨɪɨɬɤɨɯɜɢɥɶɨɜɚ ɞɿɚɬɟɪɦɿɹ, ɬɟɤɚɪɬɟɪɚɩɿɹ,
ɨɡɨɧɨɬɟɪɚɩɿɹ ɬɨɳɨ.
Ɏɨɬɨɬɟɪɚɩɿɹ (ɧɚɩɪ. ɬɟɪɚɩɿɹ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɍɎ ɜɢɩɪɨɦɿɧɸɜɚɧɧɹ, ɥɚɡɟɪɧɚ ɬɟɪɚɩɿɹ,
ɜɤɥɸɱɚɸɱɢ ɥɚɡɟɪɨɬɟɪɚɩɿɸ ɧɢɡɶɤɨʀ ɬɚ ɜɢɫɨɤɨʀ ɿɧɬɟɧɫɢɜɧɨɫɬɿ)
Ƚɿɞɪɨɬɟɪɚɩɿɹ ɬɚ ɛɚɥɶɧɟɨɬɟɪɚɩɿɹ
Ʉɥɿɦɚɬɨɬɟɪɚɩɿɹ
Ⱥɤɬɢɜɧɨɫɬɿ, ɩɨɜ'ɹɡɚɧɿ ɡ ɞɨɩɨɦɨɝɨɸ ɬɜɚɪɢɧ ɬɚ ɬɟɪɚɩɿɹ ɡ ɞɨɩɨɦɨɝɨɸ ɬɜɚɪɢɧ (ɧɚɩɪ., ɿɩɨɬɟɪɚɩɿɹ,
ɜɢɤɨɪɢɫɬɚɧɧɹ ɫɥɭɠɛɨɜɢɯ ɬɜɚɪɢɧ)
Ʌɿɦɮɨɬɟɪɚɩɿɹ (ɪɭɱɧɢɣ ɥɿɦɮɚɬɢɱɧɢɣ ɞɪɟɧɚɠ, ɩɟɪɟɦɿɠɧɚ ɩɧɟɜɦɚɬɢɱɧɚ ɤɨɦɩɪɟɫɿɹ,
ɩɟɪɟɜ’ɹɡɭɜɚɧɧɹ, ɤɿɧɟɡɿɨɬɟɣɩɭɜɚɧɧɹ)
Ƚɿɩɟɪɛɚɪɢɱɧɚ ɨɤɫɢɝɟɧɨɬɟɪɚɩɿɹ ɩɪɢ ɩɪɨɥɟɠɧɹɯ, ɜɢɪɚɡɤɚɯ ɩɚɥɶɰɿɜ, ɡɚɝɨɽɧɧɿ ɩɟɪɟɥɨɦɿɜ ɬɚ ɩɪɢ
ɧɟɜɪɨɥɨɝɿɱɧɢɯ ɫɬɚɧɚɯ, ɩɨɜ’ɹɡɚɧɢɯ ɡ ɿɲɟɦɿɽɸ (ɿɧɫɭɥɶɬ, ɑɆɌ, ɩɚɪɚɥɿɱ ɥɢɰɶɨɜɨɝɨ ɧɟɪɜɭ)
Ⱥɤɭɩɭɧɤɬɭɪɚ ɬɚ ɿɧɲɿ ɩɿɞɯɨɞɢ ɤɨɦɩɥɟɦɟɧɬɚɪɧɨʀ ɬɚ ɚɥɶɬɟɪɧɚɬɢɜɧɨʀ ɦɟɞɢɰɢɧɢ (ɧɚɩɪ.
ɜɢɤɨɪɢɫɬɚɧɧɹ ɛɚɧɨɤ)

142 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Ïðîäîâæåííÿ äîäàòêà 4À

ȿɪɝɨɬɟɪɚɩɿɹ Ⱥɧɚɥɿɡ ɿ ɧɚɜɱɚɧɧɹ ɚɤɬɢɜɧɨɫɬɹɦ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ ɿ ɡɚɧɹɬɬɹɦ

ɇɚɜɱɚɧɧɹ ɩɚɰɿɽɧɬɚ ɧɚɜɢɱɤɚɦ ɩɨɞɨɥɚɧɧɹ ɛɚɪ'ɽɪɿɜ ɭ ɜɢɤɨɧɚɧɧɿ ɚɤɬɢɜɧɨɫɬɟɣ ɩɨɜɫɹɤɞɟɧɧɨɝɨ ɠɢɬɬɹ
ɇɚɜɱɚɧɧɹ ɩɪɢ ɧɚɹɜɧɨɫɬɿ ɩɨɪɭɲɟɧɢɯ ɮɭɧɤɰɿɣ ɬɚ ɩɿɡɧɚɧɧɹ
ɇɚɜɱɚɧɧɹ ɫɬɪɚɬɟɝɿɹɦ ɞɥɹ ɨɛɦɢɧɚɧɧɹ ɤɨɝɧɿɬɢɜɧɢɯ ɩɨɪɭɲɟɧɶ
Ɋɟɚɛɿɥɿɬɚɰɿɣɧɿ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɤɟɪɭɜɚɧɧɹ ɬɪɚɧɫɩɨɪɬɧɢɦ ɡɚɫɨɛɨɦ (ɧɚɩɪ. ɨɰɿɧɤɚ ɡɚ ɞɨɩɨɦɨɝɨɸ ɫɢɦɭ-
ɥɹɬɨɪɚ ɤɟɪɭɜɚɧɧɹ, ɨɰɿɧɤɚ ɜɫɟɪɟɞɢɧɿ ɬɪɚɧɫɩɨɪɬɧɨɝɨ ɡɚɫɨɛɭ, ɬɟɫɬɭɜɚɧɧɹ ɡɚ ɤɟɪɦɨɦ, ɩɟɪɟɧɚɜɱɚɧɧɹ)
ɉɿɞɬɪɢɦɤɚ ɩɨɪɭɲɟɧɢɯ ɫɬɪɭɤɬɭɪ ɬɿɥɚ (ɧɚɩɪ. ɨɪɬɟɡɭɜɚɧɧɹ)
ȿɪɝɨɧɨɦɿɱɧɿ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɫɩɪɢɹɧɧɹ ɮɭɧɤɰɿɨɧɭɜɚɧɧɸ
ɇɚɥɚɲɬɭɜɚɧɧɹ ɫɟɪɟɞɨɜɢɳɚ ɧɚ ɪɨɛɨɬɿ ɬɚ ɜɞɨɦɚ
ȼɬɪɭɱɚɧɧɹ ɡ ɦɟɬɨɸ ɩɨɜɟɪɧɟɧɧɹ ɞɨ ɪɨɛɨɬɢ / ɜɬɪɭɱɚɧɧɹ ɡ ɭɩɪɚɜɥɿɧɧɹ ɨɛɦɟɠɟɧɧɹɦ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ
ɡ ɩɢɬɚɧɶ ɪɨɛɨɬɢ (ɫɩɪɹɦɨɜɚɧɿ ɧɚ ɨɫɨɛɭ ɬɚ ɪɨɛɨɬɭ) ɜ ɤɨɧɬɟɤɫɬɿ ɩɪɨɮɟɫɿɣɧɨʀ ɚɛɨ ɡɚɧɹɬɬɽɜɨʀ
ɪɟɚɛɿɥɿɬɚɰɿʀ (ɧɚɩɪ. ɤɨɧɫɭɥɶɬɭɜɚɧɧɹ, ɡɚɨɯɨɱɟɧɧɹ, ɧɚɜɱɚɧɧɹ, ɩɪɨɮɟɫɿɣɧɿɣ ɤɨɭɱɢɧɝ, ɩɿɞɬɪɢɦɤɚ
ɜ ɪɚɦɤɚɯ ɩɪɨɮɟɫɿʀ, ɩɫɢɯɨɫɨɰɿɚɥɶɧɟ ɤɨɧɫɭɥɶɬɭɜɚɧɧɹ, ɬɪɟɧɭɜɚɧɧɹ ɧɚɜɢɱɨɤ ɡ ɩɨɞɨɥɚɧɧɹ, ɬɟɪɚɩɿɹ
ɜɢɪɿɲɟɧɧɹ ɩɪɨɛɥɟɦ ɬɚ ɩɪɨɮɟɫɿɣɧɿ/ɡɚɧɹɬɬɽɜɿ ɧɚɜɱɚɥɶɧɿ ɜɬɪɭɱɚɧɧɹ, ɚ ɬɚɤɨɠ ɫɩɿɥɤɭɜɚɧɧɹ ɡ ɚɛɨ ɦɿɠ
ɪɨɛɨɬɨɞɚɜɰɹɦɢ / ɦɟɧɟɞɠɟɪɚɦɢ, ɪɿɜɧɢɦɢ ɤɨɧɫɭɥɶɬɚɧɬɚɦɢ ɿ ɮɚɯɿɜɰɹɦɢ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ ɞɨɞɚɬɤɨɜɨ
ɞɨ ɿɧɲɢɯ ɜɬɪɭɱɚɧɶ, ɫɩɪɹɦɨɜɚɧɢɯ ɧɚ ɡɧɢɠɟɧɧɹ ɨɛɦɟɠɟɧɶ ɚɤɬɢɜɧɨɫɬɿ ɿ ɨɛɦɟɠɟɧɶ ɦɨɠɥɢɜɨɫɬɿ
ɭɱɚɫɬɿ, ɡɚɫɬɨɫɭɜɚɧɧɹ ɞɨɩɨɦɿɠɧɢɯ ɬɟɯɧɨɥɨɝɿɣ ɬɚ ɧɚɥɚɲɬɭɜɚɧɧɹ ɪɨɛɨɱɨɝɨ ɦɿɫɰɹ
Ɍɟɪɚɩɿɹ ɡ ɞɨɩɨɦɨɝɨɸ ɩɪɢɪɨɞɢ / ɫɚɞɿɜɧɢɱɚ ɬɟɪɚɩɿɹ
Ⱥɪɬ- / ɦɭɡɢɤɨ- / ɬɚɧɰɸɜɚɥɶɧɚ ɬɟɪɚɩɿɹ
ɋɩɪɢɹɧɧɹ ɞɨɫɬɭɩɭ ɞɨ ɿɧɮɨɪɦɚɰɿɣɧɢɯ ɬɟɯɧɨɥɨɝɿɣ ɬɚ ʀɯ ɜɢɤɨɪɢɫɬɚɧɧɹ, ɜɤɥɸɱɚɸɱɢ
ɬɟɥɟɦɨɧɿɬɨɪɢɧɝ ɬɚ ɬɟɥɟɪɟɚɛɿɥɿɬɚɰɿɣɧɿ ɜɬɪɭɱɚɧɧɹ
Ɍɟɯɧɨɥɨɝɿʀ «ɪɨɡɭɦɧɨɝɨ ɛɭɞɢɧɤɭ»
ɉɿɞɜɢɳɟɧɧɹ ɦɨɬɢɜɚɰɿʀ
Ɍɟɪɚɩɿɹ ɦɨɜɢ ɬɚ ɦɨɜɥɟɧɧɹ ɇɚ ɞɨɞɚɬɨɤ ɞɨ ɬɪɚɞɢɰɿɣɧɢɯ ɦɟɬɨɞɿɜ ɬɟɪɚɩɿʀ ɦɨɜɢ ɬɚ ɦɨɜɥɟɧɧɹ, ɡɚɫɬɨɫɭɜɚɧɧɹ ɿɧɧɨɜɚɰɿɣɧɢɯ
ɜ ɪɚɦɤɚɯ ɤɨɦɩɥɟɤɫɧɢɯ ɫɩɟ- ɩɿɞɯɨɞɿɜ ɞɨ ɪɨɡɥɚɞɿɜ ɦɨɜɢ ɬɚ ɦɨɜɥɟɧɧɹ (ɧɚɩɪ. ɡɚɫɬɨɫɭɜɚɧɧɹ ɬɟɯɧɨɥɨɝɿɣ ɬɟɥɟɦɟɞɢɰɢɧɢ)
ɰɿɚɥɿɡɨɜɚɧɢɯ ɩɪɨɝɪɚɦ ɎɊɆ
Ɇɟɧɟɞɠɦɟɧɬ ɞɢɫɮɚɝɿʀ ɉɨɤɪɚɳɟɧɧɹ ɩɨɪɭɲɟɧɢɯ ɮɭɧɤɰɿɣ, ɜɢɤɨɪɢɫɬɚɧɧɹ ɤɨɦɩɟɧɫɚɰɿɣɧɢɯ ɜɬɪɭɱɚɧɶ ɞɥɹ ɫɩɪɢɹɧɧɹ
ɤɨɜɬɚɧɧɸ ɬɚ ɚɞɚɩɬɚɰɿɣɧɢɯ ɡɚɫɨɛɿɜ (ɧɚɩɪ. ɜɢɤɨɪɢɫɬɚɧɧɹ ɫɩɟɰɢɮɿɱɧɢɯ ɩɨɡ, ɦɚɧɟɜɪɿɜ
ɩɪɢ ɤɨɜɬɚɧɧɿ, ɦɨɞɢɮɿɤɚɰɿɹ ɤɨɧɫɢɫɬɟɧɰɿʀ ɿ ɪɨɡɦɿɪɭ ɛɨɥɸɫɭ, ɜɩɪɚɜɢ ɞɥɹ ɡɚɞɿɹɧɢɯ ɫɬɪɭɤɬɭɪ,
ɬɟɩɥɨɜɚ / ɬɚɤɬɢɥɶɧɚ ɫɬɢɦɭɥɹɰɿɹ, NMES, ɩɨɠɢɜɧɿ ɡɨɧɞɢ, ɜɧɭɬɪɿɲɧɶɨɪɨɬɨɜɿ ɩɪɨɬɟɡɢ)
ɇɟɣɪɨɩɫɢɯɨɥɨɝɿɱɧɿ ɜɬɪɭɱɚɧɧɹ Ʉɨɝɧɿɬɢɜɧɟ ɪɟɬɪɟɧɭɜɚɧɧɹ, ɤɨɝɧɿɬɢɜɧɚ ɫɬɢɦɭɥɹɰɿɹ ɬɚ ɤɨɦɩ'ɸɬɟɪɧɿ ɿɧɬɟɪɜɟɧɰɿʀ ɜ ɤɨɧɬɟɤɫɬɿ
ɤɨɝɧɿɬɢɜɧɨʀ ɪɟɚɛɿɥɿɬɚɰɿʀ
ɉɫɢɯɨɥɨɝɿɱɧɿ ɜɬɪɭɱɚɧɧɹ, Ʉɨɝɧɿɬɢɜɧɿ ɚɛɨ ɩɨɜɟɞɿɧɤɨɜɿ ɬɟɯɧɿɤɢ, ɜɤɥɸɱɚɸɱɢ ɞɨɞɚɬɤɨɜɿ ɬɚ ɚɥɶɬɟɪɧɚɬɢɜɧɿ ɦɟɬɨɞɢ
ɜɤɥɸɱɧɨ ɡ ɤɨɧɫɭɥɶɬɭɜɚɧɧɹɦ ɜɬɪɭɱɚɧɧɹ (ɧɚɩɪ. ɤɨɝɧɿɬɢɜɧɨ-ɩɨɜɟɞɿɧɤɨɜɚ ɬɟɪɚɩɿɹ, Acceptance and commitment therapy,
ɩɚɰɿɽɧɬɿɜ ɬɚ ʀɯ ɪɨɞɢɧ / ɫɬɪɚɬɟɝɿʀ ɪɟɥɚɤɫɚɰɿʀ, ɦɚɣɧɞɮɭɥɧɟɫ ɬɟɪɚɩɿɹ, ɦɟɞɢɬɚɰɿɹ, ɝɿɩɧɨɡ, ɛɿɨɥɨɝɿɱɧɢɣ ɡɜɨɪɨɬɧɿɣ ɡɜ'ɹɡɨɤ,
ɞɨɝɥɹɞɚɱɿɜ ɞɡɟɪɤɚɥɶɧɚ ɬɟɪɚɩɿɹ, ɤɟɪɨɜɚɧɿ ɨɛɪɚɡɢ)
ɇɭɬɪɿɬɢɜɧɚ ɬɟɪɚɩɿɹ Ⱦɿɽɬɢɱɧɿ ɜɬɪɭɱɚɧɧɹ
ɉɨɪɚɞɢ ɬɚ ɤɨɧɫɭɥɶɬɭɜɚɧɧɹ ɡ ɩɢɬɚɧɶ ɯɚɪɱɭɜɚɧɧɹ
Ɉɛɥɚɞɧɚɧɧɹ ɩɪɢ ɨɛɦɟɠɟɧɧɹɯ Ⱦɨɩɨɦɿɠɧɿ ɬɟɯɧɨɥɨɝɿʀ*, ɩɨɱɢɧɚɸɱɢ ɜɿɞ ɧɢɡɶɤɨɬɟɯɧɨɥɨɝɿɱɧɢɯ ɡɚɫɨɛɿɜ, ɬɚɤɢɯ ɹɤ ɬɪɨɫɬɢɧɢ ɞɨ
ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ, ɞɨɩɨɦɿɠɧɿ ɜɢɫɨɤɨɬɟɯɧɨɥɨɝɿɱɧɨɝɨ ɨɛɥɚɞɧɚɧɧɹ ɚɛɨ ɫɢɫɬɟɦ, ɬɚɤɢɯ ɹɤ ɦɨɬɨɪɢɡɨɜɚɧɿ ɜɿɡɤɢ ɚɛɨ
ɬɟɯɧɨɥɨɝɿʀ, ɩɪɨɬɟɡɭɜɚɧɧɹ, ɤɨɦɩ'ɸɬɟɪɢɡɨɜɚɧɿ ɫɢɫɬɟɦɢ (ɫɢɫɬɟɦɢ ɤɨɦɭɧɿɤɚɰɿʀ, ɧɚɩɪ. ɬɟɥɟɦɨɧɿɬɨɪɢɧɝ ɱɢ ɬɟɥɟɪɟɚɛɿɥɿɬɚɰɿɹ –
ɨɪɬɟɡɭɜɚɧɧɹ, ɬɟɯɧɿɱɧɿ ɡɝɚɞɚɧɿ ɜɢɳɟ) ɬɚ ɿɧɲɿ ɜ ɩɪɚɤɬɢɰɿ ɪɟɚɛɿɥɿɬɚɰɿʀ, ɜɤɥɸɱɚɸɱɢ ɪɨɛɨɬɢɡɨɜɚɧɿ ɜɬɪɭɱɚɧɧɹ
ɬɚ ɞɨɩɨɦɿɠɧɿ ɡɚɫɨɛɢ (ɪɨɛɨɬɢɡɨɜɚɧɚ ɪɟɚɛɿɥɿɬɚɰɿɹ)
ɉɚɰɿɽɧɬɢ, ɪɨɞɢɧɢ / ɞɨɝɥɹɞɚɱɿ, ɇɚɜɱɚɥɶɧɿ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɩɚɰɿɽɧɬɿɜ, ɜɤɥɸɱɚɸɱɢ ɧɚɜɱɚɧɧɹ ɫɚɦɨɨɪɝɚɧɿɡɚɰɿʀ (ɧɚɩɪ. ɲɤɨɥɚ ɫɩɢɧɢ)
ɧɚɜɱɚɧɧɹ ɩɪɨɮɟɫɿɨɧɚɥɿɜ, ɇɚɜɱɚɥɶɧɿ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɪɨɞɢɧ / ɞɨɝɥɹɞɚɱɿɜ (ɧɚɩɪ. ɜɬɪɭɱɚɧɧɹ, ɨɪɿɽɧɬɨɜɚɧɿ ɧɚ ɪɨɞɢɧɭ)
ɜɤɥɸɱɚɸɱɢ ɧɚɜɱɚɧɧɹ ɇɚɜɱɚɥɶɧɿ ɜɬɪɭɱɚɧɧɹ ɞɥɹ ɩɪɨɮɟɫɿɨɧɚɥɿɜ (ɧɚɩɪ. ɬɪɟɧɿɧɝɢ ɡ ɞɨɤɚɡɨɜɨʀ ɦɟɞɢɰɢɧɢ, ɬɪɟɧɿɧɝɢ ɡ
ɫɚɦɨɨɪɝɚɧɿɡɚɰɿʀ ɞɨɫɥɿɞɠɟɧɶ, ȻɆɈ / ȻɉɊ)
ɎɊɆ / ɪɟɚɛɿɥɿɬɚɰɿɣɧɟ Ⱦɨɝɥɹɞ, ɧɚɜɱɚɧɧɹ ɬɚ ɞɨɩɨɦɨɝɚ ɡ ɩɢɬɚɧɶ ɛɟɡɩɟɤɢ (ɧɚɩɪ. ɡɚɩɨɛɿɝɚɧɧɹ ɩɚɞɿɧɧɸ ɜ ɥɿɤɚɪɧɹɯ),
ɦɟɞɫɟɫɬɪɢɧɫɬɜɨ ɞɨɝɥɹɞ ɡɚ ɲɤɿɪɨɸ, ɫɟɱɨɜɢɦ ɦɿɯɭɪɨɦ ɬɚ ɤɢɲɤɿɜɧɢɤɨɦ, ɯɚɪɱɭɜɚɧɧɹ, ɫɨɧ ɿ ɚɞɚɩɬɚɰɿɹ ɞɨ
ɡɦɿɧɟɧɨɝɨ ɫɩɨɫɨɛɭ ɠɢɬɬɹ
Ʉɟɣɫ-ɦɟɧɟɞɠɦɟɧɬ ɲɥɹɯɨɦ ɤɨɦɭɧɿɤɚɰɿʀ ɦɿɠ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨɸ ɤɨɦɚɧɞɨɸ, ɩɚɰɿɽɧɬɨɦ ɬɚ ɪɨɞɢɧɨɸ
ɋɩɪɢɹɧɧɹ ɜɢɩɢɫɰɿ / ɩɟɪɟɫɭɜɚɧɧɸ ɦɿɠ ɡɚɤɥɚɞɚɦɢ
* ȼɢɡɧɚɱɟɧɧɹ ɞɨɩɨɦɿɠɧɨʀ ɬɟɯɧɨɥɨɝɿʀ: «Ȼɭɞɶ-ɹɤɢɣ ɩɪɟɞɦɟɬ, ɱɚɫɬɢɧɚ ɨɛɥɚɞɧɚɧɧɹ ɚɛɨ ɜɢɪɿɛ, ɧɟɡɚɥɟɠɧɨ ɜɿɞ ɬɨɝɨ, ɩɪɢɞɛɚɧɢɣ
ɜɿɧ ɤɨɦɟɪɰɿɣɧɨ, ɦɨɞɢɮɿɤɨɜɚɧɢɣ ɚɛɨ ɧɚɥɚɲɬɨɜɚɧɢɣ, ɿ ɹɤɢɣ ɜɢɤɨɪɢɫɬɨɜɭɽɬɶɫɹ ɞɥɹ ɡɛɿɥɶɲɟɧɧɹ, ɩɿɞɬɪɢɦɤɢ ɚɛɨ ɩɨɥɿɩɲɟɧɧɹ
ɮɭɧɤɰɿɨɧɚɥɶɧɢɯ ɦɨɠɥɢɜɨɫɬɟɣ ɥɸɞɟɣ ɡ ɨɛɦɟɠɟɧɧɹɦ ɠɢɬɬɽɞɿɹɥɶɧɨɫɬɿ». (Assistive Technology Act. United States Congress
2004. Public Law 108-364.Available from: www.ataporg.org/atap/atact_law.pdf)
CES: ɤɪɚɧɿɚɥɶɧɚ ɟɥɟɤɬɪɨɬɟɪɚɩɟɜɬɢɱɧɚ ɫɬɢɦɭɥɹɰɿɹ; ȻɆɈ: ɛɟɡɩɟɪɟɪɜɧɚ ɦɟɞɢɱɧɚ ɨɫɜɿɬɚ; ȻɉɊ: ɛɟɡɩɟɪɟɪɜɧɢɣ ɩɪɨɮɟɫɿɣɧɢɣ
ɪɨɡɜɢɬɨɤ; FES: ɮɭɧɤɰɿɨɧɚɥɶɧɚ ɟɥɟɤɬɪɨɫɬɢɦɭɥɹɰɿɹ; NMES: ɧɟɪɜɨɜɨ-ɦ’ɹɡɨɜɚ ɟɥɟɤɬɪɨɫɬɢɦɭɥɹɰɿɹ; RINCE: ɧɟɿɧɜɚɡɿɣɧɚ
ɤɨɪɬɢɤɚɥɶɧɚ ɟɥɟɤɬɪɨɫɬɢɦɭɥɹɰɿɹ ɡɿ ɡɧɢɠɟɧɢɦ ɿɦɩɟɞɚɧɫɨɦ; TENS: ɤɪɿɡɶɲɤɿɪɧɚ ɟɥɟɤɬɪɨɧɟɣɪɨɫɬɢɦɭɥɹɰɿɹ; PEMF: ɿɦɩɭɥɶɫɧɟ
ɟɥɟɤɬɪɨɦɚɝɧɿɬɧɟ ɩɨɥɟ; tDCS: ɬɪɚɧɫɤɪɚɧɿɚɥɶɧɚ ɫɬɢɦɭɥɹɰɿɹ ɩɨɫɬɿɣɧɢɦ ɫɬɪɭɦɨɦ; ɑɆɌ: ɱɟɪɟɩɧɨ-ɦɨɡɤɨɜɚ ɬɪɚɜɦɚ; rTMS:
ɩɨɜɬɨɪɸɜɚɥɶɧɚ ɬɪɚɧɫɤɪɚɧɿɚɥɶɧɚ ɦɚɝɧɿɬɧɚ ɫɬɢɦɭɥɹɰɿɹ; ɍɎ: ɭɥɶɬɪɚɮɿɨɥɟɬɨɜɢɣ
Ɇɨɠɥɢɜɨ ɩɟɪɟɤɪɢɬɬɹ ɩɟɪɟɪɚɯɨɜɚɧɢɯ ɜɬɪɭɱɚɧɶ ɳɨɞɨ ɩɿɞɡɚɝɨɥɨɜɤɿɜ ɜ ɥɿɜɨɦɭ ɫɬɨɜɩɰɸ (ɧɚɩɪ. ɞɟɹɤɿ ɮɿɡɢɱɧɿ ɜɬɪɭɱɚɧɧɹ ɦɨɠɭɬɶ
ɜɿɞɧɨɫɢɬɢɫɶ ɞɨ ɟɪɝɨɬɟɪɚɩɿʀ ɚɛɨ ɧɚɜɩɚɤɢ, ɩɫɢɯɨɥɨɝɿɱɧɿ ɜɬɪɭɱɚɧɧɹ ɦɨɠɭɬɶ ɬɚɤɨɠ ɫɬɚɜɢɬɢɫɹ ɞɨ ɪɿɡɧɢɯ ɨɛɥɚɫɬɟɣ ɩɪɚɤɬɢɤɢ).
Ⱥɞɚɩɬɨɜɚɧɨ / ɩɟɪɟɝɥɹɧɭɬɨ /ɪɨɡɲɢɪɟɧɨ / ɞɨɩɨɜɧɟɧɨ ɡ Ȼɿɥɨʀ ɤɧɢɝɢ ɡ ɎɊɆ ɜ ȯɜɪɨɩɿ1,2, ɚ ɬɚɤɨɠ ɡ ɩɿɡɧɿɲɢɯ ɩɭɛɥɿɤɚɰɿɣ ɳɨɞɨ ɫɮɟɪɢ
ɤɨɦɩɟɬɟɧɬɧɨɫɬɟɣ ɥɿɤɚɪɿɜ ɎɊɆ18. Ʌɿɬɟɪɚɬɭɪɚ, ɹɤɚ ɽ ɞɨɤɚɡɨɦ ɤɨɧɰɟɩɰɿʀ ɜɢɤɨɪɢɫɬɚɧɧɹ ɎɊɆ-ɜɬɪɭɱɚɧɶ, ɞɨɞɚɧɢɯ ɞɨ ɩɨɩɟɪɟɞɧɶɨɝɨ ɫɩɢɫɤɭ
ɜɬɪɭɱɚɧɶ ɡ Ȼɿɥɨʀ ɤɧɢɝɢ1,2, ɦɨɠɟ ɛɭɬɢ ɡɧɚɣɞɟɧɨɸ ɜ ɞɨɞɚɬɤɨɜɢɯ ɩɨɫɢɥɚɧɧɹɯ, ɜɤɥɸɱɚɸɱɢ ɜɢɛɪɚɧɿ ɨɝɥɹɞɢ / ɫɢɫɬɟɦɚɬɢɱɧɿ ɨɝɥɹɞɢ
(ɿ ɤɿɥɶɤɚ ɿɧɲɢɯ ɜɢɞɿɜ ɞɨɫɥɿɞɠɟɧɶ, ɹɤɿ ɫɥɭɠɚɬɶ ɯɨɪɨɲɢɦɢ ɩɪɢɤɥɚɞɚɦɢ ɩɨ ɤɨɧɤɪɟɬɧɨɦɭ ɜɬɪɭɱɚɧɧɸ ɭ ɪɚɡɿ ɜɿɞɫɭɬɧɨɫɬɿ ɨɝɥɹɞɿɜ).

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 143
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Äîäàòîê 4Á – Íåéðîìîäóëÿö³ÿ
Íåéðîìîäóëÿö³ÿ, ÿê âàæëèâå âòðó÷àííÿ ÔÐÌ, ùî ñïðÿìîâàíå íà âëàñòèâîñò³ ôóíêö³îíóâàííÿ íà ð³çíèõ ð³âíÿõ, âêëþ-
÷àþ÷è ïîðóøåííÿ, îáìåæåííÿ ä³ÿëüíîñò³ òà îáìåæåííÿ ó÷àñò³ (ç Grabljevec98).

ɇɟɣɪɨɦɨɞɭɥɹɰɿɹ ɩɪɟɞɫɬɚɜɥɹɽ ɛɭɞɶ-ɹɤɢɣ ɦɟɬɨɞ, ɳɨ ɜɢɤɨɪɢɫɬɨɜɭɽ ɧɟɿɧɜɚɡɢɜɧɢɣ ɚɛɨ ɿɧɜɚɡɢɜɧɢɣ ɩɿɞɯɿɞ, ɡ ɦɟɬɨɸ ɜɩɥɢɜɭ
ɧɚ ɚɞɚɩɬɚɰɿɸ, ɩɥɚɫɬɢɱɧɿɫɬɶ, ɫɬɪɭɤɬɭɪɧɿ ɡɦɿɧɢ ɰɟɧɬɪɚɥɶɧɨʀ ɚɛɨ ɩɟɪɢɮɟɪɢɱɧɨʀ ɧɟɪɜɨɜɨʀ ɫɢɫɬɟɦɢ. Ɋɿɡɧɨɦɚɧɿɬɧɿ ɦɟɬɨɞɢ
ɡɚɫɬɨɫɨɜɭɸɬɶɫɹ ɧɚ ɪɿɡɧɢɯ ɫɬɚɞɿɹɯ ɩɿɫɥɹ ɧɟɣɪɨɧɚɥɶɧɨɝɨ ɩɨɲɤɨɞɠɟɧɧɹ ɡ ɪɿɡɧɢɦɢ ɬɟɪɚɩɟɜɬɢɱɧɢɦɢ ɰɿɥɹɦɢ, ɹɤɿ ɩɪɚɰɸɸɬɶ
ɧɚ ɪɿɜɧɿ ɫɬɪɭɤɬɭɪ ɿ ɮɭɧɤɰɿɣ ɨɪɝɚɧɿɡɦɭ, ɚ ɬɚɤɨɠ ɚɤɬɢɜɧɨɫɬɿ ɬɚ ɭɱɚɫɬɿ.
Ɉɪɿɽɧɬɨɜɚɧɿ ɧɚ ɫɩɟɰɢɮɿɱɧɢɣ / ɨɤɪɟɦɭ ɱɚɫɬɢɧɭ / ɰɟɧɬɪ ɜ ɦɨɡɤɭ ɞɥɹ ɥɿɤɭɜɚɧɧɹ ɪɭɯɨɜɢɯ ɩɨɪɭɲɟɧɶ
 Ƚɥɢɛɨɤɚ ɫɬɢɦɭɥɹɰɿɹ ɦɨɡɤɭ (DBS)
Ɉɪɿɽɧɬɨɜɚɧɿ ɧɚ ɛɿɥɶɲɭ ɩɥɨɳɭ ɤɿɪɤɨɜɨʀ ɬɚ ɩɿɞɤɿɪɤɨɜɨʀ ɬɤɚɧɢɧɢ ɦɨɡɤɭ ɡ ɦɟɬɨɸ ɿɧɞɭɤɰɿʀ «ɦɨɞɭɥɹɰɿʀ» ɱɟɪɟɡ ɤɿɪɤɨɜɨ-ɩɿɞɤɿɪɤɨɜɿ
ɬɚ ɤɿɪɤɨɜɨ-ɤɿɪɤɨɜɿ ɦɟɪɟɠɿ ɡɚ ɞɨɩɨɦɨɝɨɸ ɬɪɚɧɫɫɢɧɚɩɬɢɱɧɨɝɨ ɩɨɲɢɪɟɧɧɹ, ɳɨ ɩɪɢɡɜɨɞɢɬɶ ɞɨ ɜɿɞɞɚɥɟɧɢɯ, ɚɥɟ ɫɩɟɰɢɮɿɱɧɢɯ
ɡɦɿɧ ɚɤɬɢɜɧɨɫɬɿ ɦɨɡɤɭ ɭ ɮɭɧɤɰɿɨɧɚɥɶɧɢɯ ɦɟɪɟɠɚɯ
 Ɍɪɚɧɫɤɪɚɧɿɚɥɶɧɚ ɦɚɝɧɿɬɧɚ ɫɬɢɦɭɥɹɰɿɹ (TMS)
 Ɍɪɚɧɫɤɪɚɧɿɚɥɶɧɚ ɫɬɢɦɭɥɹɰɿɹ ɩɨɫɬɿɣɧɢɦ ɫɬɪɭɦɨɦ (tDCS)
 Ʌɚɡɟɪɨɬɟɪɚɩɿɹ ɧɢɡɶɤɨʀ ɿɧɬɟɧɫɢɜɧɨɫɬɿ (LLLT)
Ⱦɨɫɬɚɜɤɚ ɥɿɤɚɪɫɶɤɨɝɨ ɡɚɫɨɛɭ ɿɧɬɪɚɬɟɤɚɥɶɧɨ, ɳɨɛ ɜɢɤɥɢɤɚɬɢ ɡɦɿɧɢ ɧɚ ɫɢɧɚɩɬɢɱɧɨɦɭ ɪɿɜɧɿ (ɥɿɤɭɜɚɧɧɹ ɧɟɫɬɪɢɦɧɨʀ
ɫɩɚɫɬɢɱɧɨɫɬɿ ɬɚ ɛɨɥɸ)
 ȱɧɬɪɚɬɟɤɚɥɶɧɟ ɜɜɟɞɟɧɧɹ ɥɿɤɚɪɫɶɤɨɝɨ ɡɚɫɨɛɭ (IDD)
Ɉɪɿɽɧɬɨɜɚɧɿ ɧɚ ɫɩɢɧɧɢɣ ɦɨɡɨɤ, ɳɨɛ ɩɨɥɟɝɲɢɬɢ ɯɪɨɧɿɱɧɢɣ, ɧɟɫɬɪɢɦɧɢɣ ɛɿɥɶ ɬɭɥɭɛɭ ɬɚ / ɚɛɨ ɤɿɧɰɿɜɨɤ
 ɋɬɢɦɭɥɹɰɿɹ ɫɩɢɧɧɨɝɨ ɦɨɡɤɭ (SCS)
ɋɬɢɦɭɥɹɰɿɹ ɫɚɤɪɚɥɶɧɢɯ ɧɟɪɜɿɜ ɚɛɨ ɚɮɟɪɟɧɬɧɢɯ ɜɨɥɨɤɨɧ ɝɨɦɿɥɤɨɜɨɝɨ ɧɟɪɜɭ ɞɥɹ ɦɨɞɭɥɹɰɿʀ ɧɟɣɪɨɧɚɥɶɧɨʀ ɚɤɬɢɜɧɨɫɬɿ,
ɳɨ ɜɩɥɢɜɚɽ ɧɚ ɩɨɜɟɞɿɧɤɭ ɬɚɡɨɜɨɝɨ ɞɧɚ, ɧɢɠɧɿɯ ɫɟɱɨɜɢɜɿɞɧɢɯ ɲɥɹɯɿɜ, ɫɟɱɨɜɢɯ ɬɚ ɚɧɚɥɶɧɢɯ ɫɮɿɧɤɬɟɪɿɜ ɬɚ ɬɨɜɫɬɨʀ ɤɢɲɤɢ.
 ɋɚɤɪɚɥɶɧɚ ɧɟɣɪɨɫɬɢɦɭɥɹɰɿɹ
 Ɍɿɛɿɚɥɶɧɚ ɱɟɪɟɡɲɤɿɪɧɚ ɧɟɣɪɨɫɬɢɦɭɥɹɰɿɹ, ɜɧɭɬɪɢɲɧɶɨɩɭɡɢɪɧɚ ɧɟɣɪɨɫɬɢɦɭɥɹɰɿɹ

Äîäàòîê 5. – Êðèòå𳿠äëÿ àêðåäèòàö³¿ ïðîãðàì ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè

Êðèòå𳿠äëÿ àêðåäèòàö³¿ ïðîãðàì ÔÐÌ (Êîì³òåò êë³í³÷íèõ ñòîñóíê³â Ñåêö³¿ ÔÐÌ ªÑÌÑ (ç: www.euro-prm.org/
index.php?option=com_content&view=article&id=33&Itemid=187&lang=en)

ɇɚ ɜɟɛ-ɫɚɣɬɿ ɛɭɞɟ ɩɨɤɚɡɚɧɨ ɧɚɫɬɭɩɧɢɣ ɧɚɛɿɪ ɤɪɢɬɟɪɿʀɜ ɬɚ ɞɨɞɚɧɨ ɞɨ ɲɚɛɥɨɧɭ ɞɥɹ ɩɨɜɿɞɨɦɥɟɧɧɹ ɡɚɹɜɧɢɤɚ ɬɚ ɪɟɰɟɧɡɟɧɬɿɜ.
Ɋɟɰɟɧɡɟɧɬɢ ɩɨɜɢɧɧɿ ɛɭɞɭɬɶ ɩɟɪɟɜɿɪɢɬɢ, ɱɢ ɰɿ ɩɭɧɤɬɢ ɛɭɥɢ ɜɢɤɨɧɚɧɿ.
 ɇɚɞɚɧɧɹ ɜɿɞɩɨɜɿɞɧɨʀ ɿɧɮɨɪɦɚɰɿʀ ɳɨɞɨ ɤɨɠɧɨɝɨ ɩɭɧɤɬɭ ɲɚɛɥɨɧɭ
 ȼɿɞɩɨɜɿɞɚɥɶɧɢɦ ɡɚ ɩɪɨɝɪɚɦɭ ɦɚɽ ɛɭɬɢ ɥɿɤɚɪ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ
 Ɉɫɧɨɜɢ ɩɪɨɝɪɚɦɢ ɩɨɜɢɧɧɿ ɛɭɬɢ ɩɨɜ’ɹɡɚɧɿ ɡ ɞɨɤɚɡɨɜɨɸ ɦɟɞɢɰɢɧɨɸ ɬɚ/ɚɛɨ ɨɮɿɰɿɣɧɢɦɢ ɞɚɧɢɦɢ ɬɚ/ɚɛɨ ɨɮɿɰɿɣɧɢɦɢ
ɞɨɤɭɦɟɧɬɚɦɢ
 ɇɟ ɫɥɿɞ ɩɥɭɬɚɬɢ ɩɪɢɧɰɢɩɢ ɧɚɞɚɧɧɹ ɞɨɩɨɦɨɝɢ ɡ ɎɊɆ ɡ ɨɩɢɫɨɦ ɜɦɿɫɬɭ ɩɪɨɝɪɚɦɢ
 Ɉɩɢɫ ɫɟɪɟɞɨɜɢɳɚ ɦɚɽ ɛɭɬɢ ɤɨɪɨɬɤɢɦ ɿ ɧɟ ɧɚɞɦɿɪɧɢɦ ɜɿɞɧɨɫɧɨ ɞɨ ɿɧɲɢɯ ɪɨɡɞɿɥɿɜ
 Ⱦɥɹ ɜɢɪɚɠɟɧɧɹ ɰɿɥɟɣ ɩɨɜɢɧɧɿ ɜɢɤɨɪɢɫɬɨɜɭɜɚɬɢɫɹ ɬɟɪɦɿɧɢ ɆɄɎ; ɰɿɥɿ ɬɚɤɨɠ ɩɨɜɢɧɧɿ ɛɭɬɢ ɩɿɞɫɭɦɨɜɚɧɿ ɭ ɤɨɪɨɬɤɨɦɭ
ɬɟɤɫɬɿ
 ɍ ɪɨɡɞɿɥɿ ɡ ɩɢɬɚɧɶ ɨɪɝɚɧɿɡɚɰɿʀ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ ɫɥɿɞ ɜɿɞɪɿɡɧɹɬɢ ɩɟɪɫɨɧɚɥ ɡɚɤɥɚɞɭ ɬɚ ɬɢɯ,
ɯɬɨ ɛɟɡɩɨɫɟɪɟɞɧɶɨ ɡɚɞɿɹɧɢɣ ɭ ɩɪɨɝɪɚɦɿ
 ɋɥɿɞ ɡɚɡɧɚɱɢɬɢ ɤɿɥɶɤɿɫɬɶ ɥɿɤɚɪɿɜ ɎɊɆ, ɹɤɿ ɛɟɪɭɬɶ ɭɱɚɫɬɶ ɭ ɩɪɨɝɪɚɦɿ ɎɊɆ
 Ⱦɥɹ ɩɟɪɫɨɧɚɥɭ, ɹɤɢɣ ɛɟɡɩɨɫɟɪɟɞɧɶɨ ɡɚɥɭɱɟɧɢɣ ɞɨ ɩɪɨɝɪɚɦɢ ɬɚ ɤɟɪɭɜɚɧɧɹ ɤɨɦɚɧɞɨɸ, ɦɚɽ ɛɭɬɢ ɩɨɪɿɜɧɹɧɧɹ ɡ
ɨɮɿɰɿɣɧɢɦɢ ɧɚɰɿɨɧɚɥɶɧɢɦɢ ɫɬɚɧɞɚɪɬɚɦɢ ɚɛɨ ɿɧɲɢɦɢ ɧɚɹɜɧɢɦɢ ɫɬɚɧɞɚɪɬɚɦɢ
 Ɉɛɨɜ’ɹɡɤɨɜɨɸ ɽ ɞɨɤɭɦɟɧɬɚɰɿɹ ɩɚɰɿɽɧɬɿɜ
 ɇɟɨɛɯɿɞɧɚ ɫɬɚɬɢɫɬɢɱɧɚ ɿɧɮɨɪɦɚɰɿɹ ɩɪɨ ɡɚɝɚɥɶɧɭ ɨɪɝɚɧɿɡɚɰɿɸ
 ɉɨɫɢɥɚɧɧɹ ɦɚɸɬɶ ɛɭɬɢ ɧɚɜɟɞɟɧɿ ɜ ɨɩɢɫɿ ɩɪɨɝɪɚɦɢ; ɜɨɧɢ ɩɨɜɢɧɧɿ ɛɭɬɢ ɜɿɥɶɧɨ ɞɨɫɬɭɩɧɢɦɢ ɜ ȱɧɬɟɪɧɟɬɿ ɚɛɨ ɧɚɞɚɜɚɬɢɫɹ
ɪɟɰɟɧɡɟɧɬɚɦ ɭ ɮɚɣɥɿ *.pdf
 Ⱦɥɹ ɞɨɤɭɦɟɧɬɿɜ ɧɚ ɿɧɲɢɯ ɦɨɜɚɯ ɧɟɨɛɯɿɞɧɨ ɧɚɞɚɬɢ ɤɨɪɨɬɤɟ ɪɟɡɸɦɟ ɚɧɝɥɿɣɫɶɤɨɸ ɦɨɜɨɸ.
 Ⱦɨɞɚɬɤɨɜɚ ɜɢɦɨɝɚ: ɩɟɪɟɞ ɨɫɬɚɬɨɱɧɨɸ ɚɤɪɟɞɢɬɚɰɿɽɸ ɋɟɤɰɿɽɸ ɎɊɆ ȿɋɆɋ, ɩɪɨɝɪɚɦɚ ɞɨɩɨɦɨɝɢ ɩɨɜɢɧɧɚ ɛɭɬɢ
ɩɪɟɞɫɬɚɜɥɟɧɚ ɧɚ ɧɚɰɿɨɧɚɥɶɧɨɦɭ ɪɿɜɧɿ, ɹɤ ɧɚɣɦɟɧɲ ɭ ɜɢɝɥɹɞɿ ɭɫɧɨʀ ɞɨɩɨɜɿɞɿ ɧɚ Ʉɨɧɝɪɟɫɿ ɎɊɆ. (ɐɹ ɜɢɦɨɝɚ
ɧɟ ɡɚɫɬɨɫɨɜɭɽɬɶɫɹ ɞɨ ɩɨɩɟɪɟɞɧɶɨɝɨ ɭɫɧɨɝɨ ɜɢɫɬɭɩɭ ɜ ɡɚɫɿɞɚɧɧɿ ɄɄɋ, ɞɟ ɚɜɬɨɪ ɦɨɠɟ ɫɤɨɪɢɫɬɚɬɢɫɹ ɩɢɬɚɧɧɹɦɢ
ɬɚ ɡɚɭɜɚɠɟɧɧɹɦɢ ɫɜɨʀɯ ɽɜɪɨɩɟɣɫɶɤɢɯ ɤɨɥɟɝ)
 Ɂɚɬɜɟɪɞɠɟɧɿ ɩɨɫɢɥɚɧɧɹ

144 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÂÑÒÓÏ, ÊÎÐÎÒÊÈÉ Ç̲ÑÒ ÒÀ ÌÅÒÎÄÎËÎòß

Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

(ÔÐM) â ªâðîï³.
Ðîçä³ë 8 – Ñïåö³àëüí³ñòü ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ
òà ñóñï³ëüñòâ³
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
Ó êîíòåêñò³ Á³ëî¿ Êíèãè Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ) â ªâðîï³ öåé äîêóìåíò çàéìàºòüñÿ ãëîáàëüíèì
îãëÿäîì ðîë³ ÔÐÌ ó ñèñòåìàõ îõîðîíè çäîðîâ’ÿ â ªâðîï³. ʳëüêà äîêóìåíò³â òà çâ³ò³â ÂÎÎÇ òà ÎÎÍ çàêëèêàþòü äî
ïîñèëåííÿ ðåàá³ë³òàö³¿, ÿê êëþ÷îâî¿ ñòðàòå㳿 îõîðîíè çäîðîâ’ÿ ÕÕ² ñòîð³÷÷ÿ ó ñâ³ò³. Òîìó ïîäàëüøå âïðîâàäæåííÿ
ÔÐÌ ó ñèñòåìè îõîðîíè çäîðîâ’ÿ ìຠâèð³øàëüíå çíà÷åííÿ. Áàãàòî àñïåêò³â ìàþòü áóòè âðàõîâàíèìè ïðè âïðîâàä-
æåíí³ ÔÐÌ â ñèñòåìó îõîðîíè çäîðîâ’ÿ. Îñê³ëüêè ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà ïîâèííà áóòè çàáåçïå÷åíà ïðîòÿ-
ãîì óñüîãî êîíòèíóóìó äîïîìîãè, ïîâèííà áóòè ðîçðîáëåíà ñïåöèô³÷íà ôàçîâà ìîäåëü. Ö³ ôàçè çàëåæàòü â³ä ôóíêö³î-
íàëüíèõ ïîòðåá ïàö³ºíò³â, à òàêîæ â³ä òèì÷àñîâèõ àñïåêò³â ñòàíó çäîðîâ’ÿ: â³í ìîæå áóòè âðîäæåíèì àáî íàáóòèì, ³
ðîçëàä ìîæå ìàòè ãîñòðèé, ïðîãðåñóþ÷èé àáî äåãåíåðàòèâíèé ïåðåá³ã. Ó äîêóìåíò³ îïèñàí³ íàñòóïí³ ôàçè: àá³ë³òàö³ÿ,
ïðåàá³ë³òàö³ÿ, ÔÐÌ ó ãîñòðèõ çàêëàäàõ, ó ï³äãîñòðèõ òà â äîâãîòðèâàëèõ çàêëàäàõ. Îáîâ’ÿçêîâèì º ðåãóëÿðíå ñîðòó-
âàííÿ òà ïîâòîðíå îö³íþâàííÿ, äëÿ ïðèçíà÷åííÿ ïàö³ºíòîâ³ â³äïîâ³äíîãî ð³âíÿ òà çàêëàäó ðåàá³ë³òàö³éíî¿ äîïîìîãè.
Òîìó ðåàá³ë³òàö³éí³ ñëóæáè ïîâèíí³ áóòè ñòðàòèô³êîâàíèìè òà îðãàí³çîâàíèìè ó ìåðåæ³ äëÿ çàáåçïå÷åííÿ íàéêðàùî¿
ìîæëèâî¿ äîïîìîãè, àäàïòîâàíî¿ äî ïîòðåá ³ ö³ëåé îñîáè, âïðîäîâæ ïåð³îäó äîïîìîãè. Çàáåçïå÷åííÿ ïðàâèëüíèõ ïîñëóã
ÔÐÌ ïîòðåáóº ãàðíîãî ïëàíóâàííÿ íàäàííÿ ïîñëóã, ðîçâèòêó ñïðîìîæíîñò³ òà ðîçïîä³ëó ðåñóðñ³â. Íåîáõ³äíèìè
ðåñóðñàìè º ëþäñüê³ (ç³ ñêëàäíèìè ìóëüòè-ïðîôåñ³éíèìè êîìàíäàìè), òåõí³÷í³ (ä³àãíîñòè÷íå òà òåðàïåâòè÷íå îáëàäíàí-
íÿ, îáëàäíàííÿ äëÿ âèêîíàííÿ äîäàòêîâèõ ä³àãíîñòè÷íèõ çàõîä³â, ðåàá³ë³òàö³éí³ òåõíîëî㳿 òà äîïîì³æí³ çàñîáè) òà
ô³íàíñîâ³. гøåííÿ ïðî âèä³ëåííÿ çàçâè÷àé îáìåæåíèõ ðåñóðñ³â âèìàãàþòü ïðîöåñó îá´ðóíòóâàííÿ òà ÷³òêèõ ³ ïðîçîðèõ
êðèòåð³¿â. Ñë³ä ïîâàæàòè ïðèíöèïè êë³í³÷íîãî óïðàâë³ííÿ òà çàáåçïå÷óâàòè â³äïîâ³äí³ êîìïåòåíòíîñò³. Ïðîô³ëàêòèêà
çàõâîðþâàíü (ïåðâèííà, âòîðèííà òà òðåòèííà), ï³äòðèìêà òà çàáåçïå÷åííÿ çäîðîâ’ÿ ïðè õðîí³÷íèõ ñòàíàõ, à òàêîæ
çàãàëüíå çì³öíåííÿ çäîðîâ’ÿ, ñòàþòü âñå á³ëüø âàæëèâèìè äëÿ ÔÐÌ. Âîíè âêëþ÷àþòü çàîõî÷åííÿ äî ô³çè÷íî¿ àêòèâ-
íîñò³ òà ïðîïàãàíäó çäîðîâî¿ ïîâåä³íêè, ùî ñïðÿìîâàí³ íà ï³äòðèìêó ìàêñèìàëüíîãî ôóíêö³îíóâàííÿ òà çàïîá³ãàííÿ
óñêëàäíåíü ïðè ñòàíàõ, ÿê³ ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³, àáî ïðîãðåñóþòü. Öå îáãîâîðþºòüñÿ â äîêóìåíò³
ðàçîì ç äåÿêèìè åòè÷íèìè ðîçäóìàìè ùîäî âèáîð³â, ÿê³ ë³êàð³ ÔÐÌ ïîñò³éíî ïîâèíí³ ðîáèòè ï³ä ÷àñ íàäàííÿ ïîñëóã.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 8. The PRM specialty in the healthcare system and society.
Eur J Phys Rehabil Med. 2018 Apr;54(2):261-278.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 8. Ñïåö³àëüí³ñòü ÔÐÌ â ñèñòåì³ îõîðîíè çäîðî-
â’ÿ òà ñóñï³ëüñòâ³. Óêðà¿íñüêèé æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 145–163.
Êëþ÷îâ³ ñëîâà: Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà, ªâðîïà, íàäàííÿ ïîñëóã â îõîðîí³ çäîðîâ’ÿ, âïðîâàäæåííÿ ïëàíó
îõîðîíè çäîðîâ’ÿ.

Ââåäåííÿ îñíîâè ÔÐÌ, ³ñòîð³ÿ ñïåö³àëüíîñò³ ÔÐÌ, ñòðóêòó-

Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî
óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³îíàëü-
íîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòåð³àë³â
äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìóâàííÿ ïðî
ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â ðåàá³ë³òàö³¿
òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà âàæëèâîñò³
ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ ñïåö³àëüí³ñòþ.
Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïîíÿòòÿ ÔÐÌ, ÷îìó
ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì ëþäÿì ³ ñóñï³ëüñòâó,
ðà ³ ä³ÿëüí³ñòü îðãàí³çàö³é ÔÐÌ â ªâðîï³, çíàííÿ ³
íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà êë³í³÷íèõ êîìïåòåíò-
íîñòåé ÔÐÌ, ì³ñöå ñïåö³àëüíîñò³ ÔÐÌ â ñèñòåì³
îõîðîíè çäîðîâ’ÿ ³ ñóñï³ëüñòâ³, îñâ³òà òà áåçïåðåð-
âíèé ïðîôåñ³éíèé ðîçâèòîê ë³êàð³â ÔÐÌ, îñîáëè-
âîñò³ òà ïðîáëåìè íàóêè òà äîñë³äæåíü â ÔÐÌ òà
ïðîáëåìè òà ïåðñïåêòèâè ìàéáóòíüîãî ÔÐÌ.
Ñèñòåìà îõîðîíè çäîðîâ’ÿ – öå îðãàí³çàö³ÿ
ëþäåé, çàêëàä³â òà ðåñóðñ³â, ÿê³ íàäàþòü ïîñëóãè
îõîðîíè çäîðîâ’ÿ äëÿ çàäîâîëåííÿ ïîòðåá ö³ëüîâèõ
ãðóï íàñåëåííÿ â îõîðîíè çäîðîâ’ÿ. Íà äóìêó
ÂÎÎÇ, ¿¿ îñíîâíèì íàì³ðîì º çì³öíåííÿ, â³äíîâëåí-
íÿ àáî ï³äòðèìêà çäîðîâ’ÿ.
̳ñöå ÔÐÌ â³äíîñèòüñÿ äî ð³çíèõ àñïåêò³â ³ òà
ôàç îõîðîíè çäîðîâ’ÿ äëÿ ëþäåé ç áàãàòüìà ð³çíè-

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 145
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ìè ñòàíàìè çäîðîâ’ÿ. Öåé ðîçä³ë íàäຠãëîáàëü-
íèé îãëÿä ðîë³ ÔÐÌ ó ñèñòåìàõ îõîðîíè çäîðîâ’ÿ
â ªâðîï³, çîêðåìà ùîäî: âïðîâàäæåííÿ ÔÐÌ â
ñèñòåìó îõîðîíè çäîðîâ’ÿ, ðîçâèòîê ñïðîìîæíîñò³
òà ðîçïîä³ëó ðåñóðñ³â, êë³í³÷íå óïðàâë³ííÿ òà êîì-
ïåòåíòíîñò³, ð³çíèõ ôàç ïðîöåñó ÔÐÌ òà, íàðåøò³,
ïðîô³ëàêòèêó çàõâîðþâàíü, ï³äòðèìêó çäîðîâ’ÿ òà
çì³öíåííÿ çäîðîâ’ÿ ó ñôåð³ ÔÐÌ.
Âïðîâàäæåííÿ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè â ñèñòåìàõ îõîðîíè çäîðîâ’ÿ
³äïîâ³äíî äî ÂÎÎÇ, ðåàá³ë³òàö³ÿ º ÷àñòèíîþ
óí³âåðñàëüíîãî ïîêðèòòÿ îõîðîíîþ çäîðîâ’ÿ, òà
ïîâèííà áóòè ³íòåãðîâàíà äî ïàêåòó îñíîâíèõ ïî-
ñëóã, ðàçîì ³ç ïðîô³ëàêòèêîþ, ïðîìîö³ºþ, ë³êóâàí-
íÿì òà ïàë³àòèâíîþ äîïîìîãîþ1. Ô³çè÷íà òà ðåà-
á³ë³òàö³éíà ìåäèöèíà ïîâèííà â³ä³ãðàâàòè âàæëèâó
ðîëü ó ñèñòåìàõ îõîðîíè çäîðîâ’ÿ, çîêðåìà, ó ðå-
àá³ë³òàö³¿, àëå òàêîæ é ó ïðîô³ëàêòèö³, ë³êóâàíí³ òà
ï³äòðèìö³2. Âñåñâ³òí³é çâ³ò ç îáìåæåíü æèòòºä³ÿëü-
íîñò³ îïèñóº öåíòðàëüíó ðîëü ñïåö³àëüíîñò³, ÿê
“ïîêðàùåííÿ ôóíêö³îíóâàííÿ ÷åðåç ä³àãíîñòè-
êó òà ë³êóâàííÿ ñòàí³â çäîðîâ’ÿ, çìåíøåííÿ
ïîðóøåíü òà çàïîá³ãàííÿ àáî ë³êóâàííÿ óñêëàä-
íåíü”3. ³äïîâ³äíî, “Ãëîáàëüíèé ïëàí ä³é ç îáìå-
æåíü æèòòºä³ÿëüíîñò³”4 âèçíà÷ຠ“ê³ëüê³ñòü âèïóñ-
êíèê³â íàâ÷àëüíèõ çàêëàä³â íà 10 000 íàñåëåííÿ –
çà ð³âíåì òà ñôåðîþ îñâ³òè (íàïð. ô³çè÷íà òà ðå-
àá³ë³òàö³éíà ìåäèöèíà, ô³çè÷íà òåðàï³ÿ, åðãîòåðà-
ï³ÿ, ïðîòåçóâàííÿ òà îðòåçóâàííÿ)”, ÿê îäèí ç ïî-
êàçíèê³â óñï³øíîñò³ ³ìïëåìåíòàö³¿ ðåàá³ë³òàö³éíèõ
ïîñëóã. Îñê³ëüêè äåÿê³ ðåàá³ë³òàö³éí³ ³íòåðâåíö³¿
çàñòîñîâóþòüñÿ ³íøèìè ìåäè÷íèìè ñïåö³àë³ñòàìè
òà ôàõ³âöÿìè îõîðîíè çäîðîâ’ÿ, ðîëü ÔÐÌ ó ñèñ-
òåìàõ îõîðîíè çäîðîâ’ÿ òà ðåàá³ë³òàö³¿ ïîòð³áíî
ðîçãëÿäàòè äóæå óâàæíî*.
ßê ³ ðåàá³ë³òàö³ÿ â ö³ëîìó, ÔÐÌ ïîâèííà áðàòè
íà ñåáå ðîëü íà âñ³õ ð³âíÿõ ñèñòåìè îõîðîíè çäî-
ðîâ’ÿ òà ïðîòÿãîì êîíòèíóóìó äîïîìîãè (Òàáëè-
öÿ ²). Ö³ ðåàá³ë³òàö³éí³ ïîñëóãè êëàñèô³êóþòüñÿ
íàñòóïíèì ÷èíîì (ï³äãðóïè ïîñëóã íå âðàõîâàí³),
á³ëüø äåòàëüíà ³íôîðìàö³ÿ îïèñàíà íèæ÷å â ÷àñ-
òèí³ ïðî ð³çí³ ôàçè ïðîöåñó ÔÐÌ:
À. Ãîñòð³ ðåàá³ë³òàö³éí³ ïîñëóãè íàäàþòüñÿ ó
ë³êàðíÿõ íà âòîðèííîìó òà òðåòèííîìó ð³âíÿõ.
Ãîñòð³ ðåàá³ë³òàö³éí³ ïîñëóãè ïîâèíí³ ïî÷èíàòèñÿ
íàâ³òü ï³ä ÷àñ ³íòåíñèâíî¿ òåðàﳿ, òà ïîâèíí³ ïðî-
*
Ùîäî ñïåöèô³÷íî¿ ðîë³ ÔÐÌ ó ïðîô³ëàêòèö³, ë³êóâàíí³ òà
ðåàá³ë³òàö³¿ ïðè ñïåöèô³÷íèõ ðîçëàäàõ àáî îáìåæåííÿõ æèòòº-
ä³ÿëüíîñò³ äèâèñü Êíèãó ñôåðè êîìïåòåíòíîñòåé ó ÔÐÌ (Book
on the Field of Competence of PRM ), ùî âèäàíà Êîì³òåòîì
ïðîôåñ³éíî¿ ïðàêòèêè Ñåêö³¿ ªÑÌÑ-ÔÐÌ (www.euro-prm.org)
146 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
âîäèòèñü ìóëüòè-ïðîôåñ³éíèìè êîìàíäàìè (âêëþ-
÷àþ÷è ë³êàðÿ ÔÐÌ, ô³çè÷íîãî òåðàïåâòà, åðãîòå-
ðàïåâòà òà ³íøèõ ôàõ³âö³â ðåàá³ë³òàö³¿), ÿê³ ïðàöþ-
þòü ñï³ëüíî ï³ä êåð³âíèöòâîì ë³êàðÿ ÔÐÌ. Ãîñòð³
ðåàá³ë³òàö³éí³ ïîñëóãè ìîæóòü íàäàâàòèñÿ â ñïå-
ö³àë³çîâàíèõ ïàëàòàõ ãîñòðî¿ ðåàá³ë³òàö³¿ àáî ìî-
á³ëüíèìè êîìàíäàìè ãîñòðî¿ ðåàá³ë³òàö³¿.
Á. ϳäãîñòð³ ðåàá³ë³òàö³éí³ ïîñëóãè: ï³äãîñòð³
ðåàá³ë³òàö³éí³ ïîñëóãè íàäàþòüñÿ íåãàéíî àáî îä-
ðàçó ï³ñëÿ âèïèñêè ç áëîê³â ãîñòðî¿ äîïîìîãè. Äëÿ
á³ëüø âàæêèõ âèïàäê³â (ñóòòºâ³ ñåñòðèíñüê³ òà
ìåäè÷í³ ïîòðåáè, çíà÷í³ îáìåæåííÿ ìîá³ëüíîñò³ òà
àêòèâíîñòåé ïîâñÿêäåííîãî æèòòÿ) ï³äãîñòðà ðå-
àá³ë³òàö³ÿ ìຠïðîâîäèòèñü â ñòàö³îíàðíèõ â³ää³ëåí-
íÿõ ï³äãîñòðî¿ ðåàá³ë³òàö³¿. Ïàö³ºíòè ç ìåíøèìè
îáìåæåííÿìè òàêîæ ìîæóòü áóòè ñêåðîâàí³ äî
àìáóëàòîðíèõ â³ää³ëåíü ï³äãîñòðî¿ ðåàá³ë³òàö³¿.
Äëÿ ïàö³ºíò³â ç íåçíà÷íèìè äåô³öèòàìè ìîæóòü
áóòè äîñòàòí³ìè á³ëüø ïðîñò³ âòðó÷àííÿ, íàâ³òü íà
ð³âí³ ïåðâèííî¿ ìåäè÷íî¿ äîïîìîãè. ϳäãîñòð³ ðå-
àá³ë³òàö³éí³ ïîñëóãè íà âòîðèííîìó/òðåòèííîìó
ð³âí³ ïîâèíí³ áóòè ñïåö³àë³çîâàíèìè äëÿ êîíêðåò-
íîãî ñòàíó çäîðîâ’ÿ (çàõâîðþâàííÿ àáî òðàâìè),
à òàêîæ ìàþòü ìàòè ìóëüòè-ïðîôåñ³éíó ðåàá³ë³-
òàö³éíó êîìàíäó.
Â. Äîâãîòðèâàë³ ðåàá³ë³òàö³éí³ ïîñëóãè: Äîâãî-
òðèâàë³ ðåàá³ë³òàö³éí³ ïîñëóãè ñïðÿìîâàí³ íà
ï³äòðèìêó (³ ïîë³ïøåííÿ) ôóíêö³îíóâàííÿ äëÿ îñ³á
ç äîâãîòðèâàëèìè îáìåæåííÿìè æèòòºä³ÿëüíîñò³,
àáî ç³ ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâîäÿòü äî îáìå-
æåíü æèòòºä³ÿëüíîñò³, âêëþ÷àþ÷è âðîäæåí³ îáìå-
æåííÿ æèòòºä³ÿëüíîñò³ òà õðîí³÷í³ õâîðîáè. Ó ðàç³
íåîáõ³äíîñò³, âîíè ìîæóòü áóòè âõ³äíîþ òî÷êîþ
äëÿ á³ëüø ñïåö³àë³çîâàíî¿ ðåàá³ë³òàö³¿. Äîâãîòðèâà-
ëà ðåàá³ë³òàö³ÿ ìຠâ³äáóâàòèñü çà ïðèçíà÷åííÿì òà
êîîðäèíàö³ºþ ë³êàðÿ ÔÐÌ íàâ³òü â óìîâàõ ïåðâèí-
íîãî ð³âíÿ ìåäè÷íî¿ äîïîìîãè. Äëÿ ö³º¿ ôàçè ñïîñòå-
ð³ãàºòüñÿ âñå á³ëüøå äîêàç³â íà ï³äòðèìêó ô³çè÷íèõ
âïðàâ òà àäàïòèâíî¿ ô³çè÷íî¿ àêòèâíîñò³ (äèâ. íèæ-
÷å â ÷àñòèí³ “Ïðîô³ëàêòèêà, ï³äòðèìêà çäîðîâ’ÿ òà
çì³öíåííÿ çäîðîâ’ÿ ó ÔÐÌ”). ßêùî íå ³ñíóº ñïåö³à-
ë³çîâàíî¿ ðåàá³ë³òàö³¿, ìîäåëëþ íàäàííÿ ì³í³ìàëüíèõ
ðåàá³ë³òàö³éíèõ ïîñëóã äëÿ ëþäåé, ÿê³ ¿õ ïîòðåáó-
þòü, º Ðåàá³ë³òàö³éí³ ïîñëóãè, ùî íàäàþòüñÿ â ãðî-
ìàä³ (ÐÍÃ). Öå ïîâèííî áóòè ò³ñíî ïîâ’ÿçàíî ç
³íêëþçèâíîþ ïîë³òèêîþ ðîçâèòêó ãðîìàä (ÏÐÃ).
Ïåð³îäè÷í³ ñòàö³îíàðí³ ðåàá³ë³òàö³éí³ ïîñëóãè ìî-
æóòü áóòè âèêîðèñòàí³ äëÿ ñòèìóëÿö³¿ òà ïîñèëåííÿ
âïëèâó ðåàá³ë³òàö³¿ ó ïàö³ºíò³â ç õðîí³÷íèìè ñòàíà-
ìè çäîðîâ’ÿ, òàêîæ ÿêùî âîíè ïîâ’ÿçàí³ ç ïñèõîñî-
ö³àëüíèì ñòðåñîì òà ïðîôåñ³éíèìè ïðîáëåìàìè.
Äëÿ âèêîíàííÿ ñâî¿õ çàâäàíü ïðîòÿãîì ð³çíèõ
ôàç òðàºêòî𳿠ðåàá³ë³òàö³¿, ë³êàð³ ÔÐÌ ìîæóòü
ïðàöþâàòè â áàãàòüîõ çàêëàäàõ, òàêèõ ÿê ãîñòð³,
çàãàëüí³ àáî óí³âåðñèòåòñüê³ øïèòàë³, ðåàá³ë³-
¹2(2) *2018
 ÐÎÇÄ²Ë 8 – ÑÏÅÖ²ÀËÜͲÑÒÜ ÔÐÌ Â ÑÈÑÒÅ̲ ÎÕÎÐÎÍÈ ÇÄÎÐÎÂ’ß ÒÀ ÑÓÑϲËÜÑÒ²
Òàáëèöÿ ². Ìàòðèöÿ ðåàá³ë³òàö³éíèõ ïîñëóã
Ɋɿɜɟɧɶ ɦɟɞɢɱɧɨʀ
ɞɨɩɨɦɨɝɢ A. Ƚɨɫɬɪɚ ɞɨɩɨɦɨɝɚ
Ɍɪɟɬɢɧɧɢɣ A.1: ɉɚɥɚɬɢ ɝɨɫɬɪɨʀ ɪɟɚɛɿɥɿɬɚɰɿʀ
ɪɿɜɟɧɶ ɦɟɞɢɱɧɨʀ A.2: Ɇɨɛɿɥɶɧɿ ɤɨɦɚɧɞɢ ɝɨɫɬɪɨʀ
ɞɨɩɨɦɨɝɢ ɪɟɚɛɿɥɿɬɚɰɿʀ
ȼɬɨɪɢɧɢɣ A.1: ɉɚɥɚɬɢ ɝɨɫɬɪɨʀ ɪɟɚɛɿɥɿɬɚɰɿʀ
ɪɿɜɟɧɶ ɦɟɞɢɱɧɨʀ A.2: Ɇɨɛɿɥɶɧɿ ɤɨɦɚɧɞɢ ɝɨɫɬɪɨʀ
ɞɨɩɨɦɨɝɢ ɪɟɚɛɿɥɿɬɚɰɿʀ
ɉɟɪɜɢɧɧɢɣ - Ȼ.2: Ⱥɦɛɭɥɚɬɨɪɧɿ ɜɿɞɞɿɥɟɧɧɹ
ɪɿɜɟɧɶ ɦɟɞɢɱɧɨʀ
ɞɨɩɨɦɨɝɢ
òàö³éí³ öåíòðè (ñòàö³îíàðí³ òà/àáî àìáóëàòîðí³), à
òàêîæ ó ïðèâàòí³é ïðàêòèö³, öåíòðàõ îõîðîíè çäî-
ðîâ’ÿ â ãðîìàäàõ òîùî. Ìîäåë³ íàäàííÿ ïîñëóã
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè ìîæóòü âà-
ð³þâàòè â îðãàí³çàö³éíèõ äåòàëÿõ â ð³çíèõ êðà¿íàõ,
àëå îáîâ’ÿçêîâèìè åëåìåíòàìè ïîâèíí³ áóòè íà-
ÿâí³ñòü, äîñòóïí³ñòü, ïðèéíÿòí³ñòü, òà â³äïîâ³äíà
íàóêîâà òà êë³í³÷íà ÿê³ñòü. Ó ïðèíöèï³, óñ³ âèäè
íàäàííÿ äîïîìîãè ïîâèíí³ òàêîæ áóòè â³äêðèòèìè
äëÿ ë³êàð³â ÔÐÌ. Íàðåøò³, àëå íå ìåíø âàæëèâî,
ñë³ä çàçíà÷èòè, ùî ñïåöèô³÷íèé äîñâ³ä ë³êàð³â
ÔÐÌ ìîæå áóòè âàæëèâèì äëÿ íàäàííÿ êîíñóëü-
òàö³é ùîäî ïðèéíÿòòÿ ð³øåíü ïîë³òèêàìè, ñòðàõî-
âèìè çàêëàäàìè òà êîìïàí³ÿìè, ïëàíóâàëüíèêàìè
áóä³âë³ ì³ñò òà áàãàòüìà ³íøèìè ïðîôåñ³ÿìè òà
³íñòèòóö³ÿìè ó ñôåð³ çäîðîâ’ÿ òà îáìåæåíü æèò-
òºä³ÿëüíîñò³, à òàêîæ ïðîåêòóâàííÿ ñåðåäîâèùà.
Êîëè ìîâà éäå ïðî ôàêòè÷íå âïðîâàäæåííÿ
ÔÐÌ â ñèñòåìó îõîðîíè çäîðîâ’ÿ, Êîíâåíö³ÿ ÎÎÍ
ïðî ïðàâà îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³
çàêëèêຠäåðæàâè-ó÷àñíèö³ îðãàí³çîâóâàòè,
çì³öíþâàòè òà ðîçøèðþâàòè êîìïëåêñí³ àá³ë³-
òàö³éí³ òà ðåàá³ë³òàö³éí³ ïîñëóãè é ïðîãðàìè, îñîá-
ëèâî ó ñôåð³ îõîðîíè çäîðîâ’ÿ, çàéíÿòîñò³, îñâ³òè
é ñîö³àëüíîãî îáñëóãîâóâàííÿ (Ñòàòòÿ 26)5.
Ïîñèëåííÿ ïîñëóã ç ðåàá³ë³òàö³¿, ïîâ’ÿçàíî¿ ç³
çäîðîâ’ÿì, º îäí³ºþ ç ö³ëåé Ãëîáàëüíîãî Ïëàíó ä³é
ÂÎÎÇ ç îáìåæåíü æèòòºä³ÿëüíîñò³5. Ç ö³ºþ ìåòîþ
òà â ðàìêàõ Ïëàíó ñï³âïðàö³ ÂÎÎÇ-ISPRM 2014-
2017 ðð. Gutenbrunner et al. çàïðîïîíóâàëè íà-
ñòóïí³ çàõîäè6:
– ðîçðîáèòè ìàòðèöþ òà êîíòðîëüí³ ëèñòè äëÿ
àíàë³çó ³ñíóþ÷èõ ðåàá³ë³òàö³éíèõ ïîñëóã, à òà-
êîæ âèÿâëåííÿ äèð ó íàäàíí³ ïîñëóã;
– ñòâîðèòè Äîðàä÷ó ãðóïó ç ðåàá³ë³òàö³éíèõ ïî-
ñëóã (RAT) ç åêñïåðò³â ç ðîçóì³ííÿì ãëîáàëü-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ɍɢɩɢ ɩɨɫɥɭɝ
Ȼ. ɉɿɞɝɨɫɬɪɚ ɞɨɩɨɦɨɝɚ ȼ. Ⱦɨɜɝɨɬɪɢɜɚɥɚ ɞɨɩɨɦɨɝɚ
Ȼ.1: ɋɬɚɰɿɨɧɚɪɧɿ ɜɿɞɞɿɥɟɧɧɹ ȼ.1: ɉɟɪɿɨɞɢɱɧɿ ɫɬɚɰɿɨɧɚɪɧɿ
ɩɿɞɝɨɫɬɪɨʀ ɪɟɚɛɿɥɿɬɚɰɿʀ ɪɟɚɛɿɥɿɬɚɰɿɣɧɿ ɭɫɬɚɧɨɜɢ
Ȼ.1: ɋɬɚɰɿɨɧɚɪɧɿ ɜɿɞɞɿɥɟɧɧɹ ȼ.1: ɉɟɪɿɨɞɢɱɧɿ ɫɬɚɰɿɨɧɚɪɧɿ
ɩɿɞɝɨɫɬɪɨʀ ɪɟɚɛɿɥɿɬɚɰɿʀ ɪɟɚɛɿɥɿɬɚɰɿɣɧɿ ɭɫɬɚɧɨɜɢ
Ȼ.2: Ⱥɦɛɭɥɚɬɨɪɧɿ ɜɿɞɞɿɥɟɧɧɹ
ɩɿɞɝɨɫɬɪɨʀ ɪɟɚɛɿɥɿɬɚɰɿʀ
Ȼ.3: Ɇɨɧɨ-ɩɪɨɮɟɫɿɣɧɿ ɩɿɞɝɨɫɬɪɿ
ɭɫɬɚɧɨɜɢ ɩɿɞ ɧɚɝɥɹɞɨɦ /
ɤɟɪɿɜɧɢɰɬɜɨɦ ɥɿɤɚɪɹ ɎɊɆ
ȼ.2: Ɋɟɚɛɿɥɿɬɚɰɿɣɧɿ ɰɟɧɬɪɢ
ɩɿɞɝɨɫɬɪɨʀ ɪɟɚɛɿɥɿɬɚɰɿʀ ɩɟɪɜɢɧɧɨʀ ɞɨɩɨɦɨɝɢ
Ȼ.3: Ɇɨɧɨ-ɩɪɨɮɟɫɿɣɧɿ ɩɿɞɝɨɫɬɪɿ ȼ.3: Ɇɨɧɨ-ɩɪɨɮɟɫɿɣɧɿ ɩɿɞɝɨɫɬɪɿ
ɭɫɬɚɧɨɜɢ ɩɿɞ ɧɚɝɥɹɞɨɦ / ɭɫɬɚɧɨɜɢ ɩɿɞ ɧɚɝɥɹɞɨɦ/
ɤɟɪɿɜɧɢɰɬɜɨɦ ɥɿɤɚɪɹ ɎɊɆ ɤɟɪɿɜɧɢɰɬɜɨɦ ɥɿɤɚɪɹ ɎɊɆ
ȼ.4: Ɋɟɚɛɿɥɿɬɚɰɿɣɧɿ ɩɨɫɥɭɝɢ, ɳɨ
ɧɚɞɚɸɬɶɫɹ ɜ ɝɪɨɦɚɞɿ (ɊɇȽ)
íèõ òà ðåã³îíàëüíèõ ñèñòåì îõîðîíè çäîðîâ’ÿ,
ÿê³ çìîæóòü íàäàòè êåð³âíèöòâî;
– íàäàâàòè êîíñóëüòàòèâíó äîïîìîãó êðà¿íàì, ó
ðàç³ çâåðíåíü, ÷åðåç ïðîåêòè øâèäêîãî ðåàãó-
âàííÿ, ÿê³ íàäàþòü ï³äòðèìêó äëÿ ñòâîðåííÿ
ðåàá³ë³òàö³éíèõ ïîñëóã òà íàâ÷àëüíèõ ïðîãðàì
äëÿ ðåàá³ë³òàö³éíî¿ ðîáî÷î¿ ñèëè, çà óìîâè çà-
ïèòó â³ä ÂÎÎÇ.
Îáîâ’ÿçêîâèì àñïåêòîì ïðè çì³öíåíí³ ñèñòåì
îõîðîíè çäîðîâ’ÿ äëÿ ðåàãóâàííÿ íà ïîòðåáè
ïàö³ºíò³â â ñôåð³ çäîðîâ’ÿ òà ðåàá³ë³òàö³¿ º ³íôîð-
ìàö³ÿ ïðî ôóíêö³îíóâàííÿ. Ñèñòåìè îõîðîíè çäî-
ðîâ’ÿ ïîâèíí³ çâåðòàòè óâàãó íà òå, ùî ëþäÿì âàæ-
ëèâî äëÿ ¿õ çäîðîâ’ÿ, «æèòòÿ â çäîðîâ’¿», à íå ò³ëüêè
«á³îëîã³÷íîãî çäîðîâ’ÿ». Òîæ ôóíêö³îíóâàííÿ º
òðåò³ì ³íäèêàòîðîì çäîðîâ’ÿ, êð³ì çàõâîðþâàíîñò³
òà ñìåðòíîñò³. ÌÊÔ º íàéêðàùîþ ïåðñïåêòèâîþ
äëÿ äîêóìåíòóâàííÿ òà çáîðó ³íôîðìàö³¿ ç ôóíê-
ö³îíóâàííÿ7. Ñèñòåìè îõîðîíè çäîðîâ’ÿ ìîæóòü
îòðèìóâàòè ïðèáóòîê â³ä âèêîðèñòàííÿ ³íôîðìàö³¿
ç ôóíêö³îíóâàííÿ äëÿ ïîêðàùåííÿ ì³æïðîôåñ³éíî¿
ñï³âïðàö³ òà äîñÿãíåííÿ ïåðåõðåñíèõ ðåçóëüòàò³â
ë³êóâàííÿ çàõâîðþâàíü8.
Ïðèêëàäîì òàêîãî ñïîñîáó çáîðó äàíèõ º
“̳æíàðîäíå äîñë³äæåííÿ òðàâì ñïèííîãî ìîçêó
(InSCI)”, ÿêå º îñíîâîþ “Learning Health System for
Spinal Cord Injury Initiative”9.
Ó ëþòîìó 2017 ðîêó ÂÎÎÇ çàïóñòèëà «Ðåàá³-
ë³òàö³ÿ 2030: çàêëèê äî ä³é». Öå âàæëèâà ³í³ö³àòè-
âà, ñïðÿìîâàíà íà íàðîùóâàííÿ ðåàá³ë³òàö³éíèõ ïî-
ñëóã â êðà¿íàõ ïî âñüîìó ñâ³òîâ³ â ñâ³òë³ ñó÷àñíèõ
ãëîáàëüíèõ òåíäåíö³é îõîðîíè çäîðîâ’ÿ (çðîñòàþ-
÷à ïîøèðåí³ñòü íå³íôåêö³éíèõ õâîðîá òà òðàâì) òà
ñòàð³ííÿ. Ñòóï³íü îáìåæåíü æèòòºä³ÿëüíîñò³ â
óñüîìó ñâ³ò³ âèâ÷àâñÿ ó “Global Burden of Disease
Study 2013”10.
147
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Äëÿ çàáåçïå÷åííÿ äîñòóïíîñò³ ðåàá³ë³òàö³¿ äëÿ
òèõ, õòî öüîãî ïîòðåáóº, ÂÎÎÇ ñôîðìóâàâ ñ³ì
ðåêîìåíäàö³é ùîäî ðåàá³ë³òàö³¿ â ñèñòåìàõ îõîðî-
íè çäîðîâ’ÿ:
1. Ðåàá³ë³òàö³éí³ ïîñëóãè ïîâèíí³ áóòè ³íòåãðîâàí³
äî ñèñòåì îõîðîíè çäîðîâ’ÿ;
2. Ðåàá³ë³òàö³éí³ ïîñëóãè ïîâèíí³ áóòè ³íòåãðîâàí³
äî ïåðâèííîãî, âòîðèííîãî òà òðåòèííîãî ð³âí³â
ñèñòåìè îõîðîíè çäîðîâ’ÿ òà ì³æ öèõ ð³âí³â;
3. Ïîâèíí³ áóòè äîñòóïíèìè ìóëüòè-äèñöèïë³íàðí³
êàäðîâ³ ðåñóðñè ç ðåàá³ë³òàö³¿ (“ìóëüòè-äèñöèï-
ë³íàðíà” áóëî âèçíà÷åíî ÂÎÎÇ, ïðîòå êîðåêò-
íèì º òåðì³í “ìóëüòè-ïðîôåñ³éíà” – äèâ. ãëî-
ñàð³é);
4. Äîñòóïíèìè ìàþòü áóòè ðåàá³ë³òàö³éí³ ïîñëó-
ãè ÿê â ãðîìàä³, òàê ³ ë³êàðí³;
5. ˳êàðí³ ïîâèíí³ âêëþ÷àòè ñïåö³àë³çîâàí³ ñòàö³î-
íàðí³ ðåàá³ë³òàö³éí³ áëîêè äëÿ ïàö³ºíò³â ³ç ñêëàä-
íèìè ïîòðåáàìè;
6. Ô³íàíñîâ³ ðåñóðñè ïîâèíí³ áóòè ñïðÿìîâàí³ íà
ðåàá³ë³òàö³éí³ ñëóæáè äëÿ âïðîâàäæåííÿ òà
ï³äòðèìêè ðåêîìåíäàö³é ùîäî íàäàííÿ ïîñëóã;
7. Òàì, äå ìåäè÷íå ñòðàõóâàííÿ ³ñíóº, àáî áóäå
äîñòóïíèì, âîíî ïîâèííî âêëþ÷àòè ðåàá³ë³-
òàö³éí³ ïîñëóãè.
Ó Â³ää³ë³ îáìåæåíü æèòòºä³ÿëüíîñò³ òà ðåàá³-
ë³òàö³¿ ÂÎÎÇ ðîçðîáëÿþòüñÿ Íàñòàíîâè ç ðåàá³-
ë³òàö³¿, ïîâ’ÿçàíî¿ ç³ çäîðîâ’ÿì, ÿê³ íàäàâàòèìóòü
ðåêîìåíäàö³¿ äåðæàâàì-÷ëåíàì òà â³äïîâ³äíèì
çàö³êàâëåíèì ñòîðîíàì, ùî äîïîìîæóòü ïðèéíÿòè
îá´ðóíòîâàí³ ð³øåííÿ ïðè ïîáóäîâ³ àáî çì³öíåíí³
ñèñòåì ðåàá³ë³òàö³¿11. Äîñë³äíèöüê³ ïèòàííÿ òà ïî-
äàëüø³ ðåêîìåíäàö³¿ â íàñòàíîâàõ ´ðóíòóþòüñÿ íà
øåñòè áàçîâèõ åëåìåíòàõ ñèñòåìè îõîðîíè çäîðî-
â’ÿ: êåð³âíèöòâî òà óïðàâë³ííÿ, íàäàííÿ ïîñëóã,
êàäðîâ³ ðåñóðñè, ³íôîðìàö³éí³ ñèñòåìè, äîñòóï äî
îñíîâíèõ ë³ê³â/äîïîì³æíèõ òåõíîëîã³é òà ô³íàíñó-
âàííÿ. Òîìó â Íàñòàíîâàõ ç ðåàá³ë³òàö³¿, ïîâ’ÿçà-
íî¿ ç³ çäîðîâ’ÿì, áóäóòü íàäàí³ ðåêîìåíäàö³¿ ùîäî
³ìïëåìåíòàö³¿ ðåàá³ë³òàö³¿ íà ð³âí³ ñèñòåì, ÿê ñòðà-
òå㳿 îõîðîíè çäîðîâ’ÿ, à í³ ñïåöèô³÷íèõ ðåàá³ë³òà-
ö³éíèõ âòðó÷àíü.
Íàäàííÿ ïîñëóã – öå îäèí ç øåñòè áàçîâèõ åëå-
ìåíò³â ñèñòåì îõîðîíè çäîðîâ’ÿ. Òîìó äëÿ îáëàñò³
ðåàá³ë³òàö³¿, ïîâ’ÿçàíî¿ ç³ çäîðîâ’ÿì, áóëî çàïðîïî-
íîâàíî êîíöåïòóàëüíèé îïèñ ðåàá³ë³òàö³éíèõ ïî-
ñëóã12. Ç ìåòîþ çàêðèòòÿ ïðîãàëèí ó íàö³îíàëüíèõ
òà/àáî ðåã³îíàëüíèõ ñèñòåìàõ ðåàá³ë³òàö³¿ òà ïî-
äàëüøîãî ðîçâèòêó â³äïîâ³äíèõ ðåàá³ë³òàö³éíèõ
ïîñëóã âàæëèâèì º âèçíà÷åííÿ ºäèíèõ êðèòåð³¿â òà
çàãàëüíîïðèéíÿòî¿ ìîâè äëÿ îïèñó òà êëàñèô³êàö³¿
ðåàá³ë³òàö³éíèõ ïîñëóã. Ðîáî÷à ãðóïà Êîì³òåòó
çâ’ÿçêó ISPRM-ÂÎÎÇ ðîçðîáëÿº ïåðåë³ê âèì³ð³â òà
êàòåãîð³é, ùî îïèñóþòü îðãàí³çàö³þ ñëóæá ðåàá³-
ë³òàö³¿, ïîâ’ÿçàíî¿ ç³ çäîðîâ’ÿì, â ðàìêàõ “̳æíà-
148 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ðîäíî¿ êëàñèô³êàö³¿ îðãàí³çàö³¿ ïîñëóã äëÿ ðåàá³ë³-
òàö³¿, ïîâ’ÿçàíî¿ ç³ çäîðîâ’ÿì” (ICSO-R)13. Ó ðàì-
êàõ ºâðîïåéñüêî¿ ³í³ö³àòèâè ùîäî âïðîâàäæåííÿ
ÌÊÔ òà ICSO-R â ðàìêàõ ñèñòåìè óïðàâë³ííÿ
ÿê³ñòþ ðåàá³ë³òàö³¿ â ñ³÷í³ 2016 ð. ó Íîòâ³ë³ (Øâåé-
öàð³ÿ), â³äáóâñÿ ñåì³íàð åêñïåðò³â Ñåêö³¿ òà Ðàäè
ÔÐÌ ªÑÌÑ. ϳä ÷àñ öüîãî ñåì³íàðó áóëî ÷³òêî
ïðîäåìîíñòðîâàíî äîö³ëüí³ñòü òà çàñòîñîâí³ñòü
ICSO-R äëÿ îïèñó ðåàá³ë³òàö³¿, ïîâ’ÿçàíî¿ ç³ çäî-
ðîâ’ÿì 14. Âèêîðèñòàííÿ ICSO-R ïðèçâîäèòü äî
á³ëüø òî÷íîãî òà ïîð³âíÿëüíîãî îïèñó ðåàá³ë³òà-
ö³éíèõ ïîñëóã ó ïîð³âíÿíí³ ç ï³äõîäîì îïèñó ñëî-
âàìè. Òàêèì ÷èíîì, ðåêîìåíäîâàíî âèêîðèñòîâó-
âàòè ICSO-R äëÿ îïèñó òà ïîð³âíÿííÿ ³ñíóþ÷èõ
ðåàá³ë³òàö³éíèõ ïîñëóã, à òàêîæ ìîäåëåé ïîñëóã â
ÿêîñò³ îïîðíèõ òî÷îê, âïðîâàäæåíí³ ðåàá³ë³òàö³é-
íèõ ïîñëóã â ñèñòåìàõ îõîðîíè çäîðîâ’ÿ òà ó ðàì-
êàõ ïðîòîêîëó óïðàâë³ííÿ êë³í³÷íîþ ÿê³ñòþ.
Ó á³ëüøîñò³ ºâðîïåéñüêèõ êðà¿í ÔÐÌ, ÿê ìå-
äè÷íà ñïåö³àëüí³ñòü, òàê ³ ðåàá³ë³òàö³éíà ïîñëóãà
äîñèòü äîáðå ðîçâèíåíà íà ïðîòÿç³ êîíòèíóóìó
äîïîìîãè ïàö³ºíòàì ç ðåàá³ë³òàö³éíèìè ïîòðåáàìè
òà ö³ëÿìè. Îäíàê äåÿê³ ïðîãàëèíè çàëèøàþòüñÿ.
Òàêèì ÷èíîì, öÿ ñïåö³àëüí³ñòü â äàíèé ÷àñ º
â³äñóòíüîþ â îäí³é êðà¿í³ ªâðîïåéñüêîãî Ñîþçó
(ªÑ) (Äàí³ÿ), à òàêîæ ó äåÿêèõ ºâðîïåéñüêèõ êðà¿-
íàõ, ÿê³ íå º ÷ëåíàìè ªÑ.
Ó Ðîñ³¿, à òåïåð é â Óêðà¿í³ ðîáî÷à ãðóïà Ñåêö³¿
ÔÐÌ ªÑÌÑ ï³äòðèìóº ðîçâèòîê ñïåö³àëüíîñò³
ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà.  Ðîñ³¿ íåùî-
äàâíî áóëî ñòâîðåíî ³ìïëåìåíòàö³éíèé ï³ëîòíèé
ïðîåêò “Ðîçâèòîê ñèñòåìè ìåäè÷íî¿ ðåàá³ë³òàö³¿ â
Ðîñ³éñüê³é Ôåäåðàö³¿ (DOME)”. Ãîëîâíîþ ìåòîþ
º ïðîäåìîíñòðóâàòè åôåêòèâí³ñòü «íîâî¿» ìîäåë³
ñèñòåìè ìåäè÷íî¿ ðåàá³ë³òàö³¿ ïîð³âíÿíî ç òðàäè-
ö³éíîþ ìîäåëëþ íà òðüîõ êàòåãîð³ÿõ ïàö³ºíò³â (ç
ãîñòðîþ öåðåáðîâàñêóëÿðíîþ ïî䳺þ, ãîñòðèì
êîðîíàðíèì ñèíäðîìîì òà ï³ñëÿ åíäîïðîòåçóâàí-
íÿ êóëüøîâîãî ñóãëîáó).
Äîòåïåð ³ñíóº äóæå ìàëî ë³òåðàòóðè ùîäî âïðî-
âàäæåííÿ ðåàá³ë³òàö³éíèõ ïðîåêò³â ó êðà¿íàõ ç âè-
ñîêèì ³ ñåðåäí³ì ð³âíåì äîõîäó. Ó 2013 ðîö³ Austra-
lian Agency for Clinical Innovation îïóáë³êóâàëî äóæå
äåòàëüíèé ïîñ³áíèê “Íàá³ð ³íñòðóìåíò³â ç âïðîâàä-
æåííÿ ðåàá³ë³òàö³¿”, ÿêèé ìîæíà âèêîðèñòîâóâàòè ÿê
äîâ³äêîâó ìîäåëü, ùî îïèñóº ø³ñòü çàêëàä³â íàäàí-
íÿ äîïîìîãè, â ÿêèõ íàäàþòüñÿ ðåàá³ë³òàö³éí³ ïîñëó-
ãè15. Âîíè ñòâåðäæóþòü, ùî öå º îñíîâîþ äëÿ åôåê-
òèâíîãî íàäàííÿ ðåàá³ë³òàö³éíèõ ïîñëóã, ùî ïàö³ºíò
îòðèìóº «ïðàâèëüíó äîïîìîãó ó ïðàâèëüíîìó ì³ñö³
â ïîòð³áíèé ÷àñ» ç ï³äòðèìóþ÷èìè êëþ÷îâèìè
ñêëàäîâèìè ïîäîðîæ³ ïàö³ºíòà, çàãàëüíèìè äëÿ âñ³õ
çàêëàä³â. Êîëè ïàö³ºíò ïîòðàïëÿº äî ðåàá³ë³òàö³¿ òà
ïåðåñóâàºòüñÿ ì³æ çàêëàäàìè íàäàííÿ äîïîìîãè,
³ñíóº ïîâòîðþâàíà ñõåìà íàñòóïíèõ ñòàä³é: ñêåðó-
¹2(2) *2018
 ÐÎÇÄ²Ë 8 – ÑÏÅÖ²ÀËÜͲÑÒÜ ÔÐÌ Â ÑÈÑÒÅ̲ ÎÕÎÐÎÍÈ ÇÄÎÐÎÂ’ß ÒÀ ÑÓÑϲËÜÑÒ²
âàííÿ/íàäõîäæåííÿ, îö³íþâàííÿ/íàäàííÿ ïîñëóã òà
âèïèñêà/çì³íà âèäó äîïîìîãè.
Äåÿê³ ³íø³ âàæëèâ³ áàçîâ³ åëåìåíòè äëÿ âïðî-
âàäæåííÿ ÔÐÌ â ñèñòåìó îõîðîíè çäîðîâ’ÿ áó-
äóòü ðîçãëÿíóò³ â íàñòóïíèõ ðîçä³ëàõ (ëþäñüê³
ðåñóðñè, ô³íàíñóâàííÿ òà êë³í³÷íå óïðàâë³ííÿ,
âêëþ÷àþ÷è àêðåäèòàö³þ).
Íàðåøò³, âïðîâàäæåííÿ ÔÐÌ â ñèñòåìàõ îõî-
ðîíè çäîðîâ’ÿ ïîâèííî áóòè êîíòåêñò-ñïåöèô³÷íèì,
îá´ðóíòîâàíèì ïðèéíÿòòÿì ð³øåíü, çàñíîâàíèì íà
äîêàçàõ, ùî âêëþ÷àþòü íàéêðàù³ ïðàêòèêè òà ó
ò³ñí³é ñï³âïðàö³ ç óñ³ìà çàö³êàâëåíèìè ñòîðîíàìè,
âêëþ÷àþ÷è ïàö³ºíò³â òà ³íøèõ ñïîæèâà÷³â.
Ðîçâèòîê ñïðîìîæíîñò³ òà ðîçïîä³ë
ðåñóðñ³â ó ô³çè÷í³é òà ðåàá³ë³òàö³éí³é
ìåäèöèí³
Ðîçâèòîê ñïðîìîæíîñò³ ìîæå áóòè âèçíà÷åíèé,
ÿê âòðó÷àííÿ, ùî çì³íèëè çäàòí³ñòü îðãàí³çàö³¿ ÷è
ãðîìàäè âèð³øóâàòè ïèòàííÿ îõîðîíè çäîðîâ’ÿ
øëÿõîì ñòâîðåííÿ íîâèõ ñòðóêòóð, ï³äõîä³â òà/àáî
ö³ííîñòåé16.
Öå – áóäü-ÿêà ñïåöèô³÷íà ä³ÿ ÷è ñåð³ÿ ä³é, ùî
ï³äâèùóþòü åôåêòèâí³ñòü îêðåìèõ îñ³á, îðãàí³-
çàö³é ÷è ñèñòåì, âêëþ÷àþ÷è îðãàí³çàö³éíó òà ô³íàí-
ñîâó ñòàá³ëüí³ñòü, ïðîãðàìíå íàäàííÿ ïîñëóã òà
ÿê³ñòü ïðîãðàìè äëÿ ñòâîðåííÿ ïîçèòèâíèõ çì³í òà
ï³äâèùåííÿ åôåêòèâíîñò³ äëÿ ïîêðàùåííÿ ðåçóëü-
òàò³â ãðîìàäñüêîãî çäîðîâ’ÿ17.
Ó äåÿêèõ ºâðîïåéñüêèõ çàêëàäàõ ìåäè÷í³ òà
ðåàá³ë³òàö³éí³ ïîñëóãè äëÿ ëþäåé ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ àáî ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâî-
äÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³, çàëèøàþòüñÿ
ñóáîïòèìàëüíèìè. Ñòàòò³ 20, 25 òà 26 Êîíâåíö³¿ ïðî
ïðàâà îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³4 âèìà-
ãàþòü â³ä äåðæàâ-÷ëåí³â ðîçðîáêè ïî÷àòêîâîãî òà
áåçïåðåðâíîãî íàâ÷àííÿ äëÿ ôàõ³âö³â òà ïåðñîíà-
ëó ç ìåòîþ ïîêðàùåííÿ äîñòóïó äî ³íêëþçèâíî¿
äîïîìîãè ó ñôåð³ îõîðîíè çäîðîâ’ÿ, äîïîì³æíèõ
òåõíîëîã³é òà ðåàá³ë³òàö³éíèõ ïîñëóã. Ö³ë³ Ãëîáàëü-
íîãî ïëàíó ä³é ÂÎÎÇ ç îáìåæåíü æèòòºä³ÿëüíîñò³
íà 2014-2021 ðîêè òàêîæ çàêëèêàþòü äåðæàâè-
÷ëåíè ïîñèëèòè òà ïîë³ïøèòè äîñòóï äî ïîñëóã ç
ðåàá³ë³òàö³¿, äîïîì³æíèõ òåõíîëîã³é òà ðåàá³ë³òàö³¿,
ùî íàäàºòüñÿ â ãðîìàä³ (ÐÍÃ). Ðîçâèòîê öèõ ñïðî-
ìîæíîñòåé íàáóâຠâñå á³ëüøîãî çíà÷åííÿ â ñâ³òë³
çðîñòàþ÷èõ òåíäåíö³é íå³íôåêö³éíèõ çàõâîðþâàíü,
ñòàð³ííÿ íàñåëåííÿ òà çðîñòàþ÷î¿ ê³ëüêîñò³ ëþäåé,
ÿê³ æèâóòü ç íàñë³äêàìè òðàâì18. Äëÿ ðîçâèòêó òà
ïëàíóâàííÿ â³äïîâ³äíî¿ ñïðîìîæíîñò³ ÔÐÌ ó ð³çíèõ
ºâðîïåéñüêèõ êðà¿íàõ íåîáõ³äí³ ð³çí³ âèäè ðåñóðñ³â,
òàê³, ÿê ëþäñüê³ ðåñóðñè òà òåõí³÷í³ ðåñóðñè.
Ñòîñîâíî ëþäñüêèõ ðåñóðñ³â, öå, â ïåðøó ÷åð-
ãó, ë³êàð³ ÔÐÌ, âîíè ïîâèíí³ áóòè íàâ÷åí³ íàëåæ-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
íèì ÷èíîì (Ðîçä³ë 9). ʳëüê³ñòü ë³êàð³â ÔÐÌ â
êðà¿í³ ìຠáóòè äîñòàòíüîþ, ùîá çàáåçïå÷èòè ðåà-
á³ë³òàö³éí³ ïîòðåáè íàñåëåííÿ, àëå íå ïîâèííà ïåðå-
âèùóâàòè öüîãî ÷èñëà, ùîá óíèêíóòè íàäì³ðíîãî
ñïîæèâàííÿ ðåàá³ë³òàö³éíî¿ äîïîìîãè. Ïîë³òèêè ïî-
âèíí³ ïðèéìàòè äîêàçîâî îá´ðóíòîâàí³ ð³øåííÿ, ùî
´ðóíòóþòüñÿ íà ïðàâèëüíèõ äàíèõ òà ïðîãíîçàõ.
Öå, î÷åâèäíî, ñòîñóºòüñÿ ³ ³íøèõ ôàõ³âö³â ðåàá³-
ë³òàö³¿, ùî ñêëàäàþòü ðåàá³ë³òàö³éí³ êîìàíäè (Ðîç-
ä³ëè 3 òà 7). Íå âñ³ ïðîôåñ³¿ ùå äîáðå ïðåäñòàâ-
ëåí³ ó âñ³õ êðà¿íàõ, ³ öå ïèòàííÿ ìຠáóòè âèð³øåíî
ªâðîïåéñüêèìè îðãàíàìè íà ºâðîïåéñüêîìó ð³âí³.
˳êàð³ ÔÐÌ â³ä³ãðàþòü âàæëèâó ðîëü ó íàâ÷àëü-
íèõ ïðîãðàìàõ ôàõ³âö³â ðåàá³ë³òàö³¿, òàêèõ ÿê, íà-
ïðèêëàä, ô³çè÷í³ òåðàïåâòè àáî åðãîòåðàïåâòè.
Òåõí³÷í³ ðåñóðñè âêëþ÷àþòü çàêëàäè, îáëàä-
íàííÿ òà ðåàá³ë³òàö³éí³ òåõíîëî㳿, çàëåæíî â³ä âèäó
ñòàíó çäîðîâ’ÿ òà ñïåöèô³÷íèõ ðåàá³ë³òàö³éíèõ
ö³ëåé ïàö³ºíò³â.
Ñïîñîáè íàäàííÿ ô³íàíñîâèõ ðåñóðñ³â äëÿ ðåà-
á³ë³òàö³éíèõ ïîñëóã, â³äð³çíÿþòüñÿ â ð³çíèõ ºâðî-
ïåéñüêèõ êðà¿íàõ (Ðîçä³ë 2). Ó á³ëüøîñò³ ºâðî-
ïåéñüêèõ êðà¿í ³íòåðâåíö³¿ ô³çè÷íî¿ òà
ðåàá³ë³òàö³éíî¿ ìåäèöèíè ïîêðèâàþòüñÿ äåðæàâ-
íèì ñòðàõîâèì ïàêåòîì, îñîáëèâî äëÿ ñïåö³àë³çî-
âàíî¿ ãîñòðî¿ ðåàá³ë³òàö³¿, ÷àñòî äîïîâíþºòüñÿ
äîäàòêîì ç êèøåí³ ïàö³ºíòà, ÿêèé çàçâè÷àé º á³ëü-
øèì ïðè õðîí³÷í³é òà äîâãîòðèâàë³é äîïîìîç³.
Îòæå, ðîçïîä³ë ðåñóðñ³â íà ä³ÿëüí³ñòü ô³çè÷íî¿ òà
ðåàá³ë³òàö³éíî¿ ìåäèöèíè â á³ëüøîñò³ âèïàäê³â âèç-
íà÷àºòüñÿ ïîë³òèêàìè îõîðîíè çäîðîâ’ÿ. Àäåêâàò-
íèé çá³ð äàíèõ, à òàêîæ äîñë³äæåííÿ åôåêòèâíîñò³
ðåàá³ë³òàö³éíèõ ³íòåðâåíö³é, º íàäçâè÷àéíî âàæëè-
âèì äëÿ òîãî, ùîá äîïîìîãòè ïîë³òèêàì òà àäì³-
í³ñòðàòîðàì ïðèéíÿòè ñïðàâåäëèâ³ òà äîêàçîâî îá-
´ðóíòîâàí³ áþäæåòí³ ð³øåííÿ. Äîñë³äæåííÿ, ùî,
éìîâ³ðíî, ïîêðàùèòü êë³í³÷íó ïðàêòèêó, ïåðåäáà-
÷àþòü íàÿâí³ñòü êðèòè÷íî¿ ìàñè äîñë³äíèê³â, ùî
ïðàöþþòü, ÿê êîìàíäè, ó ñïðèÿòëèâèõ ñåðåäîâè-
ùàõ. Íà æàëü, â ðåàá³ë³òàö³éí³é ìåäèöèí³ ³ñíóº
íàäòî ìàëî äîñë³äíèöüêî¿ ñïðîìîæíîñò³ òàêîãî
ðîäó, ùîá çàáåçïå÷èòè íàä³éíå ìàéáóòíº äëÿ ö³º¿
ñôåðè. Òîæ â ñôåð³ ðåàá³ë³òàö³éíî¿ íàóêè âàæëèâèì
º ðîçâèòîê ñïðîìîæíîñò³19.
Âèð³øåííÿ íà ìàêðî-ð³âí³, ÿê ðîçïîä³ëÿòè ðåñóð-
ñè äëÿ ðåàá³ë³òàö³¿ ïîð³âíÿëüíî ç ³íøèìè ñôåðàìè
îõîðîíè çäîðîâ’ÿ – ãîëîâíèì ÷èíîì ë³êóâàííÿì òà
(ïåðâèííîþ) ïðîô³ëàêòèêîþ – ³ ÿê ðîçïîä³ëÿòè ðå-
ñóðñè ì³æ ð³çíèìè îáëàñòÿìè ðåàá³ë³òàö³¿ – ðåàá-
³ë³òàö³ÿ ïðè àìïóòàö³ÿõ, ðåàá³ë³òàö³ÿ ïðè ³íñóëüò³,
ðåàá³ë³òàö³ÿ ïðè ïàòîëî㳿 ñåðöÿ, ðåàá³ë³òàö³ÿ ïðè
ñïèííîìîçêîâèõ òðàâìàõ, òà ³íøå – âèìàãຠàðãó-
ìåíòîâàíîãî ïðîöåñó. ª á³ëüø í³æ îäèí ñïîñ³á
âèçíà÷åííÿ, ùî º ñïðàâåäëèâèì, íàïð. â³äïîâ³äíî
äî òÿæêîñò³ ñòàíó çäîðîâ’ÿ (äå ÷èì á³ëüø ñåðé-
149
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
îçí³ ïðîáëåìè ç³ çäîðîâ’ÿì ó ïîïóëÿö³¿, òèì á³ëüøå
âîíà çàñëóãîâóº íà öå), ïîð³âíÿíî ç ïåðñïåêòèâà-
ìè óñï³õó (îõîðîíè çäîðîâ’ÿ).  îñíîâ³ òàêèõ ð³çíèõ
ñïîñîá³â âèçíà÷åííÿ ñïðàâåäëèâîñò³ ëåæàòü ð³çí³
ö³ííîñò³, íàïð. ïîòðåáà, ùî ëåæèòü â îñíîâ³ «òÿæ-
êîñò³», ´ðóíòóºòüñÿ íà òåî𳿠ñïðàâåäëèâîñò³ áëà-
ãîïîëó÷÷ÿ, òîä³ ÿê ðåçóëüòàò, ùî ëåæèòü â îñíîâ³
«óñï³õó», ìຠíà óâàç³ óòèë³òàðíó òåîð³þ ñïðàâåä-
ëèâîñò³ (âèçíàþ÷è, ùî îáèäâ³ ï³äõîäè íå º âçàºìî-
âèêëþ÷íèìè àáî âè÷åðïíèìè). гøåííÿ ö³º¿ òà ³íøèõ
ïîä³áíèõ ïðîáëåì ðîçïîä³ëó ðåñóðñ³â, ïîâ’ÿçàíèõ ç
ðåàá³ë³òàö³ºþ, ìîæå âèìàãàòè ðîçðîáêè ïîë³òèêè, ÿêà
äóæå ïîâ’ÿçàíà ç ôîðìàëüíèìè ãðîìàäñüêèìè äèñ-
êóñ³ÿìè, ùî ´ðóíòóþòü åòèêó íà ïîë³òè÷íèõ ðåàë-
³ÿõ â øèðîêîìó ñåíñ³20.
Íà ìåçî- ³ ì³êðî-ð³âí³ â³äá³ð ïàö³ºíò³â, ÿê³ ïî-
âèíí³ áóòè ïðèéíÿò³ ðåàá³ë³òàö³éíèìè ñëóæáàìè,
ïîâèíåí çä³éñíþâàòèñÿ ë³êàðåì ÔÐÌ. Îñê³ëüêè â
áàãàòüîõ öåíòðàõ ïîïèò íà íàäõîäæåííÿ ïåðåâè-
ùóº ê³ëüê³ñòü äîñòóïíèõ ë³æîê, âàæê³ ð³øåííÿ ïðèé-
ìàþòüñÿ ùîäíÿ. ˳êàð³ ÔÐÌ ÷àñòî çìóøåí³ ãðà-
òè ðîëü âîðîòàðÿ ðåàá³ë³òàö³éíîãî öåíòðó. ßêùî
ïîòðåáè ïàö³ºíò³â ïåðåâèùóþòü íàÿâí³ ðåñóðñè,
íåîáõ³äíî ïðèéíÿòè ð³øåííÿ ùîäî ðîçïîä³ëó ðå-
ñóðñ³â. ˳êàð ÔÐÌ ïîâèíåí íàìàãàòèñÿ äîñÿãòè
áàëàíñó ì³æ ìèëîñåðäÿì òà ñïðàâåäëèâ³ñòþ21.
Êë³í³÷íå óïðàâë³ííÿ òà êîìïåòåíòíîñò³
ó ô³çè÷í³é òà ðåàá³ë³òàö³éí³é ìåäèöèí³
Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà – öå ìåäè÷-
íà ñïåö³àëüí³ñòü, ÿêà çîñåðåäæóºòüñÿ íà óñï³øíî-
ìó ìåíåäæìåíò³, ç òî÷êè çîðó ïåðñïåêòèâ ³íäèâ³-
äóóìó, çì³í òà âòðàò. ÔÐÌ º íàéá³ëüø â³äì³ííîþ,
êîëè âîíà íàâ÷ຠ³ ðîçïîâñþäæóº ñïîñ³á ìèñëåí-
íÿ, ÿêèé íàäຠïàö³ºíòàì òà êë³í³öèñòàì ìîæ-
ëèâ³ñòü êåðóâàòè ñèòóàö³ÿìè, ïîâ’ÿçàíèìè ç îáìå-
æåííÿìè æèòòºä³ÿëüíîñò³, à í³ ôîêóñóºòüñÿ íà
ë³êóâàíí³ îñíîâíîãî ñòàíó 22 . ˳êàð³ ÔÐÌ º
íàéá³ëüø åôåêòèâíèìè òà íåîáõ³äíèìè äëÿ óïðàâ-
ë³ííÿ á³ëüø ñêëàäíèìè ñòàíàìè òà ñòàíàìè, ùî
ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³. Ó òà-
êîìó êîíòåêñò³ ë³êàðåì ÔÐÌ áóäå âèêîíóâàòèñü
ê³ëüêà ðîëåé, âêëþ÷àþ÷è ðîëü ãðîìàäñüêîãî çäî-
ðîâ’ÿ, ÿêà ñïðÿìîâàíà íà ìàðã³íàë³çàö³þ òà çíåñè-
ëåííÿ â³ä ñåðåäîâèùíèõ àáî ñîö³àëüíèõ ñòðóêòóð,
òà âñòàíîâëþº ðåàá³ë³òàö³þ, ÿê êëþ÷îâó ÷àñòèíó
âñ³õ ìåäè÷íèõ âòðó÷àíü. Ëþäè ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ òà ñòàíàìè çäîðîâ’ÿ, ÿê³ ìîæóòü
ïðèçâåñòè îò öèõ îáìåæåíü, ìàþòü îñîáëèâèé
ðèçèê íèçüêî¿ ÿêîñò³ ìåäè÷íî¿ äîïîìîãè23.
Êë³í³÷íå óïðàâë³ííÿ
Êë³í³÷íå óïðàâë³ííÿ º ïðîçîðèì òà ï³äçâ³òíèì
ïðîöåñîì, ÿêèé ðåòåëüíî âèâ÷ຠåôåêòèâí³ñòü ÿê
150 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
³íäèâ³äóóìó, òàê é ñëóæáè, äëÿ çàïîá³ãàííÿ àáî
âèïðàâëåííÿ ïðîáëåì, ïåðø í³æ ïàö³ºíòè çàçíàþòü
òðàâì àáî ïåðñîíàë áóäå ïîêàðàíèì. Öå ìຠï³äâè-
ùèòè ÿê³ñòü äîïîìîãè, îð³ºíòîâàíî¿ íà îñîáó, òà
äåìîíñòðóâàòè óïîâíîâàæåíèì, ìåíåäæåðàì òà
ïàö³ºíòàì, ùî ñëóæáà â³äïîâ³äຠïðèéíÿòíèì ñòàí-
äàðòàì24. öå çàëåæèòü â³ä:
– âïðîâàäæåííÿ íàö³îíàëüíèõ òà ì³æíàðîäíèõ
ñòàíäàðò³â òà íàñòàíîâ;
- ðîçðîáîê, ïðîâåäåííÿ òà ðîçïîâñþäæåííÿ
àóäèò³â, ùî ïðîâîäÿòüñÿ çà òàêèìè ñòàíäàðòà-
ìè, âïðîâàäæåííÿ ðåêîìåíäàö³é òà íàñòóïíèõ
ïîâòîðíèõ àóäèò³â (Ðåâ³ç³éíèé öèêë);
– â³çèò³â äî çàêëàä³â äëÿ âïåâíåííÿ, ùî ïîòðåáè
âðàçëèâèõ ëþäåé, ÿê³ îòðèìóþòü ðåàá³ë³òàö³éí³
ïîñëóãè, º çàäîâîëåíèìè (Òàáë. ²²);
– çáèðàííÿ íàö³îíàëüíî óçãîäæåíèõ ïîêàçíèê³â
åôåêòèâíîñò³ ðåàá³ë³òàö³éíèõ ïîñëóã â òàêèõ çàê-
ëàäàõ (Òàáë. ²²). Á³ëüø âåëèê³ çàêëàäè ìîæóòü
ïîòðåáóâàòè ³íäèâ³äóàëüíî¿ àêðåäèòàö³¿ ì³æíà-
ðîäíèìè îðãàíàìè, òàêèìè ÿê Êîì³òåò êë³í³÷íèõ
ñòîñóíê³â Ñåêö³¿ ÔÐÌ ªÑÌÑ àáî CARF;
– ï³äòðèìêè ðåãóëÿðíî¿ îö³íêè åôåêòèâíîñò³ òà
ïîòðåá ó ðîçâèòêó ë³êàð³â ÔÐÌ (Òàáë. ²²²);
– åêñïåðòíî¿ îö³íêè. Åôåêòèâí³ñòü ë³êàðÿ ÔÐÌ íå
ìîæå áóòè â³äîêðåìëåíà â³ä åôåêòèâíîñò³ ðåà-
á³ë³òàö³éíî¿ êîìàíäè. Ìóëüòè-ïðîôåñ³éíèé
â³çèò, ÿêèé âèêîíóºòüñÿ ë³êàðåì ÔÐÌ, ìåäè÷-
íîþ ñåñòðîþ, ìåíåäæåðîì òà òåðàïåâòàìè,
ìîæå îö³íèòè ôóíêö³îíóâàííÿ ÿê ö³ëî¿ êîìàíäè
÷è ñëóæáè, òàê ³ ë³êàð³â ÔÐÌ âñåðåäèí³;
– çâîðîòíîãî çâ’ÿçêó â³ä ïàö³ºíòà òà ðîäèíè. ÔÐÌ
ìຠáóòè äèñöèïë³íîþ ç âèñîêîþ ïåðñîíà-öåí-
òðè÷í³ñòþ, ç íàëåæíîþ óâàãîþ äî çàõîïëåííÿ
æèòòºâîãî äîñâ³äó ÿê ïàö³ºíò³â, òàê ³ ðîäèí.
˳êàð³ ÔÐÌ ïðàöþþòü ó â³äíîñí³é ìåäè÷í³é ³çî-
ëÿö³¿ â äåÿêèõ êðà¿íàõ ³ ïîâèíí³ áðàòèñÿ çà øèðî-
êèé ñïåêòð ñêëàäíèõ ìåäè÷íèõ ñòàí³â. Ìåõàí³çìè
óïðàâë³ííÿ ïîâèíí³ çàáåçïå÷óâàòè, ùîá ñòàðø³
êë³í³öèñòè ðåãóëÿðíî êîíòàêòóâàëè ç ³íøèìè ë³êà-
ðÿìè ÔÐÌ, à òàêîæ ³íòåãðóâàëèñÿ äî òà îòðèìó-
âàëè ï³äòðèìêó êîëåã ³íøèõ ñïåö³àëüíîñòåé25, òîæ
¿ì íå ïîòð³áíî ïðàêòèêóâàòè çà ìåæàìè ñâîãî ñïå-
öèô³÷íîãî äîñâ³äó.
Äëÿ äîñÿãíåííÿ öüîãî ðåêîìåíäóºòüñÿ, ùîá
êîæíà ñëóæáà âèçíà÷èëà ïðîâ³äíîãî êë³í³öèñòà,
ÿêèé íåñå îñîáëèâó â³äïîâ³äàëüí³ñòü çà óïðàâë³í-
íÿ. Öåé êë³í³öèñò ïîâèíåí:
1. âèçíà÷àòè â³äïîâ³äí³ íàñòàíîâè òà ñòàíäàðòè;
2. îðãàí³çîâóâàòè òà î÷îëþâàòè ðåãóëÿðí³ ëî-
êàëüí³ òà ðåã³îíàëüí³ óïðàâë³íñüê³ çáîðè òà ñïðè-
ÿòè êîíòàêòàì ç ïîâ’ÿçàíèìè ñïåö³àëüíîñòÿìè;
3. îïèñóâàòè óïðàâë³íñüêó àêòèâí³ñòü â³äïîâ³äíèì
îðãàíàì òà çâ³òóâàòè ïðî íåñïðèÿòëèâ³ ³íöèäåí-
¹2(2) *2018
 ÐÎÇÄ²Ë 8 – ÑÏÅÖ²ÀËÜͲÑÒÜ ÔÐÌ Â ÑÈÑÒÅ̲ ÎÕÎÐÎÍÈ ÇÄÎÐÎÂ’ß ÒÀ ÑÓÑϲËÜÑÒ²

Òàáëèöÿ ²² – Îö³íêà ë³êàð³â ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè

ȼɿɞɩɨɜɿɞɧɿ ɧɚɜɢɱɤɢ ɬɚ ɩɨɜɟɞɿɧɤɚ
1. Ʉɨɦɭɧɿɤɚɰɿɣɧɿ ɬɚ ɦɿɠɨɫɨɛɢɫɬɿɫɧɿ ɧɚɜɢɱɤɢ.
2. ɉɨɜɚɝɚ, ɜɜɿɱɥɢɜɿɫɬɶ ɿ ɫɩɿɜɱɭɬɬɹ ɞɨ ɩɟɪɫɨɧɚɥɭ, ɩɚɰɿɽɧɬɿɜ ɬɚ ɪɨɞɢɧ.
3. ȿɮɟɤɬɢɜɧɟ ɭɩɪɚɜɥɿɧɧɹ ɫɬɚɰɿɨɧɚɪɨɦ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ.
4. ȿɮɟɤɬɢɜɧɚ ɩɪɚɤɬɢɤɚ ɮɿɡɢɱɧɨʀ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɦɟɞɢɰɢɧɢ ɜ ɤɥɿɧɿɰɿ ɬɚ ɜ ɝɪɨɦɚɞɿ.
5. ɉɪɨɰɟɞɭɪɧɿ ɧɚɜɢɱɤɢ ɬɚ ɩɪɢɡɧɚɱɟɧɧɹ.
6. Ɋɨɡɜɢɬɨɤ ɤɨɦɚɧɞɢ.
7. Ɋɨɡɜɢɬɨɤ ɭɫɬɚɧɨɜɢ.
8. Ⱥɞɟɤɜɚɬɧɚ ɪɟɚɤɰɿɹ ɬɚ ɧɚɜɱɚɧɧɹ ɜɿɞ ɫɤɚɪɝ ɬɚ ɧɟɫɩɪɢɹɬɥɢɜɢɯ ɿɧɰɢɞɟɧɬɿɜ.
9. ɍɱɚɫɬɶ ɭ ɛɟɡɩɟɪɟɪɜɧɨɦɭ ɩɪɨɮɟɫɿɣɧɨɦɭ ɪɨɡɜɢɬɤɭ, ɤɥɿɧɿɱɧɨɦɭ ɭɩɪɚɜɥɿɧɧɿ ɬɚ ɩɨɥɿɩɲɟɧɧɿ ɹɤɨɫɬɿ.
10. ɍɱɚɫɬɶ ɭ ɦɭɥɶɬɢ-ɩɪɨɮɟɫɿɣɧɨɦɭ ɧɚɜɱɚɧɧɿ ɬɚ ɞɨɫɥɿɞɠɟɧɧɹɯ.
ȼɿɞɩɨɜɿɞɧɿ ɦɟɬɨɞɢ ɞɨɤɭɦɟɧɬɭɜɚɧɧɹ ɬɚ ɨɰɿɧɸɜɚɧɧɹ
1. ɋɚɦɨɨɰɿɧɤɚ ɬɚ ɿɧɞɢɜɿɞɭɚɥɶɧɚ ɪɟɮɥɟɤɫɿɹ.
2. Ɂɜɿɬɭɜɚɧɧɹ ɩɪɨ ɩɨɫɥɭɝɢ: ɞɿɹɥɶɧɿɫɬɶ ɬɚ ɪɟɡɭɥɶɬɚɬɢ.
3. Ɂɜɨɪɨɬɧɢɣ ɡɜ'ɹɡɨɤ ɞɥɹ ɛɚɝɚɬɶɨɯ ɞɠɟɪɟɥ.
4. Ⱥɭɞɢɬɨɪɫɶɤɿ ɡɜɿɬɢ, ɚɧɨɧɿɦɧɿ ɤɥɿɧɿɱɧɿ ɥɢɫɬɢ ɬɚ ɜɢɩɢɫɧɿ ɟɩɿɤɪɢɡɢ.
5. Ɂɚɞɨɜɨɥɟɧɧɹ ɩɚɰɿɽɧɬɚ.
6. Ɂɜɿɬɭɜɚɧɧɹ ɩɪɨ ɩɨɛɿɱɧɿ ɞɿʀ.
7. ɋɤɚɪɝɢ ɬɚ ɩɨɯɜɚɥɢ.
8. ɉɪɨɬɨɤɨɥɸɜɚɧɧɹ ɨɫɜɿɬɢ.
9. ɉɪɨɬɨɤɨɥɸɜɚɧɧɹ ɧɚɜɱɚɧɧɹ ɬɚ ɡɜɨɪɨɬɧɨɝɨ ɡɜ’ɹɡɤɭ.
10. Ƚɪɚɧɬɨɜɿ ɡɚɹɜɤɢ, ɪɟɡɭɥɶɬɚɬɢ ɞɨɫɥɿɞɠɟɧɶ ɬɚ ɩɭɛɥɿɤɚɰɿʀ.
11. Ɇɭɥɶɬɢ-ɩɪɨɮɟɫɿɣɧɚ ɟɤɫɩɟɪɬɧɚ ɨɰɿɧɤɚ.
12. ɉɥɚɧ ɩɟɪɫɨɧɚɥɶɧɨɝɨ ɪɨɡɜɢɬɤɭ.

òè òà ñêàðãè ðàçîì ³ç ïðîïîíóâàííÿì ïëàíó âè- (Rehabilitation International: http://www.riglobal.org/

ð³øåííÿ ñïðèéìàíèõ òðóäíîù³â;
4. ñïðèÿòè ïîë³ïøåííþ ÿêîñò³ âñ³º¿ ñëóæáè. Öå
ìîæëèâî ëèøå çà íàÿâíîñò³ ñï³ëüíî¿ ñòðóêòóðè
óïðàâë³ííÿ òà áþäæåòó. Ñëóæáè ïîâèíí³ óíèêà-
òè ÷ëåí³â êîìàíäè, ÿê³ ïðàöþþòü ó ð³çíèõ óñ-
òàíîâàõ òà ìàþòü äåê³ëüêà ë³í³éíèõ êåð³âíèê³â.
ÔÐÌ çàëåæèòü â³ä çàñòîñóâàííÿ ìíîæèííèõ
íàâè÷îê â ³íäèâ³äóàëüíîìó òà óçãîäæåíîìó ïîðÿä-
êó äëÿ âèð³øåííÿ ñêëàäíèõ òà ³íäèâ³äóàëüíèõ ïðî-
áëåì. Òàêèì ÷èíîì, âîíà çàëåæèòü â³ä ¿¿ óñï³õ³â ó
íàëàãîäæåíí³ êîìóí³êàö³¿ òà âçàºìî䳿 â ðåàá³ë³-
òàö³éí³é êîìàíä³ òà âïåâíåíî¿ äîâ³ðè ïàö³ºíòà â ñïå-
öèô³÷íîìó äîñâ³ä³ òèõ, õòî â³äïîâ³äຠçà âòðó÷àííÿ.
Êîìïåòåíòíîñò³ òà ñòðóêòóðè êë³í³÷íîãî óïðàâ-
ë³ííÿ, îïèñàí³ â öüîìó ðîçä³ë³, ìàþòü ïåâíèì ÷èíîì
çàáåçïå÷èòè, ùîá öÿ äîâ³ðà íå áóëà íåäîðå÷íîþ.
гçí³ ôàçè ïðîöåñó ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
Ôàçîâà ìîäåëü ïðîöåñó ÔÐÌ âêëþ÷ຠôàçè
ïðîòÿãîì êîíòèíóóìó äîïîìîãè. Ö³ ð³çí³ ôàçè ïðî-
öåñó ÔÐÌ çàëåæàòü â³ä ÷àñîâèõ àñïåêò³â ñòàíó
çäîðîâ’ÿ: âðîäæåí³ àáî íàáóò³, ³ ÿêùî âîíè íàáóò³,
÷è º âîíè ãîñòðèìè, àáî ïðîãðåñóþ÷èìè ÷è äåãå-
íåðàòèâíèìè.
ϳä ÷àñ çðîñòàííÿ âèêîðèñòîâóºòüñÿ òåðì³í “àá³-
ë³òàö³ÿ”. Àá³ë³òàö³ÿ – öå ïðîöåñ, ñïðÿìîâàíèé íà
äîïîìîãó îñîá³ ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ â
äîñÿãíåíí³, çáåðåæåíí³ àáî âäîñêîíàëåíí³ íàâè÷îê
³ ôóíêö³îíóâàííÿ äëÿ ïîâñÿêäåííîãî æèòòÿ
projects/habilitation-rehabilitation/)25. Öåé òåðì³í âèï-
ëèâຠç âèñîêî¿ àäàïòèâíîñò³ òà çâ’ÿçêó âñ³õ ôóíêö³é
îðãàí³çìó ï³ä ÷àñ ðîñòó, ³ âêëþ÷àº: íàéêðàùèé ìîæ-
ëèâèé çàëèøêîâèé ðîçâèòîê ïîðóøåíî¿ ôóíêö³¿, íà-
áóòòÿ íîâèõ (êîìïåíñàòîðíèõ) íàâè÷îê òà óíèêíåííÿ
âïëèâó íà íîðìàëüíèé ðîçâèòîê ôóíêö³é, ÿê³ áåç-
ïîñåðåäíüî íå ïîñòðàæäàëè. Àá³ë³òàö³ÿ ó ä³òåé ç
(âðîäæåíèì àáî ðàíî íàáóòèì) ïîðóøåííÿì àáî îá-
ìåæåííÿìè æèòòºä³ÿëüíîñò³ ñêëàäàºòüñÿ ç áåçïå-
ðåðâíîãî ïðîöåñó, ç á³ëüø ³íòåíñèâíèìè ôàçàìè
â³äïîâ³äíî äî åòàï³â ðîçâèòêó. Ö³ ïîñëóãè ÷àñòî
íàäàþòüñÿ â Ñëóæáàõ ðîçâèòêó äèòèíè.
Ïðè ãîñòðîìó íàáóòò³ ñòàíó çäîðîâ’ÿ, ôàçè
ÔÐÌ òðàäèö³éíî ïîä³ëÿþòüñÿ íà ãîñòðó, ï³äãîñò-
ðó òà äîâãîòðèâàëó ôàçè. Çîâñ³ì íåäàâíî òàêîæ
áóëà ðîçðîáëåíà “ïðåàá³ë³òàö³ÿ” ÿê ñòðàòåã³ÿ
ÔÐÌ. Âîíà ñêëàäàºòüñÿ ç íàâ÷àëüíî¿ ïðîãðàìè òà
äîîïåðàö³éíîãî ô³çè÷íîãî òà/àáî ïñèõîëîã³÷íîãî
êîíäèö³îíóâàííÿ, ùî ï³äâèùóº ôóíêö³îíàëüí³ òà
ïñèõ³÷í³ çäàòíîñò³, ñïðÿìîâàí³ íà ïîë³ïøåííÿ ï³ñëÿ-
îïåðàö³éíèõ ôóíêö³îíàëüíèõ ðåçóëüòàò³â. ˳òåðàòó-
ðà, ïåðåâàæíî â ãàëóç³ îðòîïåäè÷íî¿ ÷è îíêîëîã³÷-
íî¿ õ³ðóð㳿, íàäຠðàíí³ äîêàçè ïðî òå, ùî
ïðåàá³ë³òàö³ÿ ìîæå çìåíøèòè òðèâàë³ñòü ïåðåáó-
âàííÿ ³, ìîæëèâî, çàáåçïå÷èòè ï³ñëÿîïåðàö³éí³
ô³çè÷í³ ïåðåâàãè26.
ÔÐÌ â ãîñòðèõ çàêëàäàõ
Ãîñòðà àáî ðàííÿ ô³çè÷íà òà ðåàá³ë³òàö³éíà
ìåäèöèíà ñêëàäàºòüñÿ ç ïðîãðàìè ñïåö³àë³çîâàíî¿
ìåäè÷íî¿ ðåàá³ë³òàö³¿ ï³ä ÷àñ íàäõîäæåííÿ äî ãî-

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 151
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ñòðî¿ ë³êàðí³ ï³ñëÿ òðàâìè àáî õâîðîáè, àáî â ðå-
çóëüòàò³ êîìïëåêñíîãî ìåäè÷íîãî ë³êóâàííÿ àáî
éîãî óñêëàäíåíü. Öå òàêîæ ìîæå çàñòîñîâóâàòè-
ñÿ äî ãîñòðî¿ ïî䳿 â îñîáè ç ³ñíóþ÷èì îáìåæåí-
íÿì æèòòºä³ÿëüíîñò³ (íàïð. ðàïòîâèé ðåöèäèâ
ìíîæèííîãî ñêëåðîçó, àëå òàêîæ ïåðåëîì ñòåãíà
ó ï³ñëÿ³íñóëüòíîãî ïàö³ºíòà, àáî âàæêà ³íôåêö³ÿ ó
ïàö³ºíòà ç³ spina bifida). Ðåàá³ë³òàö³éí³ çàõîäè ï³äëÿ-
ãàþòü êë³í³÷í³é â³äïîâ³äàëüíîñò³ ë³êàðÿ ÔÐÌ,
âêëþ÷àþ÷è âíåñîê ìóëüòè-ïðîôåñ³éíî¿ ðåàá³ë³òà-
ö³éíî¿ êîìàíäè, à òàêîæ ³íøèõ â³äïîâ³äíèõ ìåäè÷-
íèõ òà õ³ðóðã³÷íèõ ñïåö³àëüíîñòåé, ïî÷èíàþ÷è ç
åï³çîäó ³íòåíñèâíî¿ òåðàﳿ. Öå øèðîêî îïèñóºòü-
ñÿ Ward, à êë³í³÷íà ä³ÿëüí³ñòü äåòàë³çîâàíà
Stam25,27. Ãîñòðà ðåàá³ë³òàö³ÿ ñïðÿìîâàíà íà çàïî-
á³ãàííÿ óñêëàäíåíü ³ììîá³ë³çàö³¿ (íàïð. ñàðêîïå-
í³ÿ, îðòîñòàòè÷íà äèñôóíêö³ÿ, êîíòðàêòóðè, òðîì-
áîç) òà âòîðèííèõ ñòàí³â (íàïð. íåéðîãåííèé
ñå÷îâèé ì³õóð òà êèøê³âíèê, ãåòåðîòîï³÷íà îññè-
ô³êàö³ÿ àáî ñïàñòè÷í³ñòü) òà ïîë³ïøåííÿ ôóíêö³é
òà àêòèâíîñò³ (íàïð. ìîá³ëüí³ñòü, êîîðäèíàö³ÿ, àê-
òèâíîñò³ ïîâñÿêäåííîãî æèòòÿ). Àêöåíò ðåàá³ë³òà-
ö³éíîãî âòðó÷àííÿ òàêîæ âêëþ÷ຠìåíåäæìåíò
áîëþ, ³íôîðìóâàííÿ òà íàâ÷àííÿ ïàö³ºíò³â òà ¿õ
ðîäèí, íàâ÷àííÿ ïåðñîíàëó ï³äðîçä³ë³â ãîñòðî¿ äî-
ïîìîãè, ïðîãíîçóâàííÿ òà ðîçðîáêà ïëàíó ðåàá³ë³-
òàö³¿ äëÿ çàáåçïå÷åííÿ ñîðòóâàííÿ äëÿ ïîäàëüøèõ
ðåàá³ë³òàö³éíèõ ïðîãðàì. Îòæå, ðîëü ë³êàðÿ ÔÐÌ
ó ãîñòð³é ðåàá³ë³òàö³¿ ïîëÿãຠâ îö³íþâàíí³ òà ìîí³-
òîðèíãó ñòàíó çäîðîâ’ÿ ïàö³ºíò³â (íàïð. äèõàííÿ,
êîâòàííÿ, ðóõîâ³ ôóíêö³¿ àáî ôóíêö³¿ âåãåòàòèâíî¿
íåðâîâî¿ ñèñòåìè, ôóíêö³¿ ñåðöåâî-ñóäèíí³, ñå÷î-
âîãî ì³õóðà òà êèøê³âíèêà, ðîçëàäè êîâòàííÿ),
çàñòîñîâóþ÷è ôàðìàöåâòè÷í³ ³ ô³çè÷í³ âèäè ë³êó-
âàííÿ òà êîîðäèíàö³þ ìóëüòè-ïðîôåñ³éíî¿ ðåàá³ë³-
òàö³éíî¿ êîìàíäè25. Öå ïîòðåáóº âèñîêîãî ð³âíÿ
ï³äãîòîâêè â ãîñòðèõ ìåäè÷íèõ ñòàíàõ òà ³íòåíñèâ-
íî¿ òåðàﳿ òà ïîâèííî ïðîâîäèòèñÿ ó ò³ñí³é ñï³âïðàö³
ç ³íøèìè ìåäè÷íèìè ñïåö³àë³ñòàìè. Êîìàíäíà
ðîáîòà ç ðåãóëÿðíèìè êîíñóëüòàö³ÿìè òà çáîðàìè
êîìàíäè ìຠâèð³øàëüíå çíà÷åííÿ äëÿ óñï³øíî¿
äîïîìîãè â ãîñòð³é ðåàá³ë³òàö³¿ 25,28. Ó áàãàòüîõ
ºâðîïåéñüêèõ êðà¿íàõ, òàêèõ, ÿê ͳìå÷÷èíà, êåð³â-
íèöòâî ãîñòðèõ ðåàá³ë³òàö³éíèõ êîìàíä ë³êàðåì
ÔÐÌ º îáîâ’ÿçêîâèì çà ïðàâèëàìè îõîðîíè çäî-
ðîâ’ÿ 29.
Ãîñòðà ðåàá³ë³òàö³ÿ ìîæå áóòè íàäàíà ê³ëüêî-
ìà ñïîñîáàìè, ÿê³ òàêîæ ìîæíà îá’ºäíàòè çàëåæ-
íî â³ä ðîçì³ðó òà êîíòåêñòó ë³êàðí³:
– Ïåðåâåäåííÿ ïàö³ºíò³â äî ë³æîê ÔÐÌ àáî äî
áëîêó ÔÐÌ ó ë³êàðí³, ùî íàäຠãîñòðó äîïîìî-
ãó (áëîê ãîñòðî¿ ðåàá³ë³òàö³¿ ÷è ÁÃÐ);
– ³ää³ëåííÿ ÔÐÌ ç ìîá³ëüíèì â³äâ³äóâàííÿì
êîìàíäàìè ÔÐÌ ï³ä â³äïîâ³äàëüí³ñòþ ë³êàðÿ
ÔÐÌ (êîìàíäà ãîñòðî¿ ðåàá³ë³òàö³¿ àáî ÊÃÐ),
152 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ïðè òîìó, ùî ïàö³ºíò çàëèøàºòüñÿ íà ë³æêó
ñïåö³àë³ñòà, ÿêèé ñêåðóâàâ äî ÔÐÌ. ijàãíîñ-
òè÷í³ ïðîöåäóðè òà âòðó÷àííÿ ÔÐÌ ìîæóòü
ïðîâîäèòèñü ó â³ää³ëåíí³ ÔÐÌ àáî ó ïàëàò³,
çàëåæíî â³ä çàãàëüíîãî òà ìåäè÷íîãî ñòàíó
ïàö³ºíòà;
– Ìîá³ëüíå â³äâ³äóâàííÿ êîìàíäîþ ÔÐÌ ï³ä
â³äïîâ³äàëüí³ñòþ ë³êàðÿ ÔÐÌ, ïàö³ºíò çàëè-
øàºòüñÿ íà ë³æêó ñïåö³àë³ñòà, ÿêèé ñêåðóâàâ äî
ÔÐÌ (êîìàíäà ãîñòðî¿ ðåàá³ë³òàö³¿ àáî ÊÃÐ);
– Ùîäåíí³ â³çèòè äî ïàëàò ãîñòðî¿ äîïîìîãè
ë³êàð³â ÔÐÌ ç îêðåìîãî çàêëàäó ÔÐÌ (ðåä.
ÿê³é íå âõîäèòü äî ñêëàäó äàíî¿ ë³êàðí³);
– Ãîñòð³ ï³äðîçä³ëè â öåíòðàõ ÔÐÌ àáî ðåàá³ë³-
òàö³éíèõ ë³êàðíÿõ, çäàòí³ ë³êóâàòè ïàö³ºíò³â ç
íåîáõ³äí³ñòþ ïîñò³éíîãî ãîñòðîãî ìåäè÷íîãî
ë³êóâàííÿ, äëÿ óìîæëèâëåííÿ íàäõîäæåííÿ
ïàö³ºíò³â äóæå ðàíî äëÿ ïî÷àòêó ïðîãðàì ÔÐÌ;
–  óí³âåðñèòåòñüêèõ ë³êàðíÿõ òà âåëèêèõ ë³êàð-
íÿõ ãîñòðî¿ äîïîìîãè áëîê àáî â³ää³ëåííÿ ÔÐÌ
ìຠáóòè ïðèñóòí³ì äëÿ çàáåçïå÷åííÿ ðåàá³ë³-
òàö³¿ â ãîñòð³é ôàç³.
Ñòâîðåííÿ ãîñòðèõ òà ðàíí³õ ïðîãðàì ÔÐÌ ïðè-
ñêîðþº òåìï â³äíîâëåííÿ íåçàëåæíîñò³ òà ïðèçâî-
äèòü äî á³ëüø ðàííüî¿ âèïèñêè. Á³ëüø òîãî, âîíè
çìåíøóþòü óñêëàäíåííÿ òà á³ëü, îïòèì³çóþòü
ôóíêö³îíóâàííÿ, âèÿâëÿþòü êîãí³òèâí³ òà åìîö³éí³
ïðîáëåìè ïðè ÷åðåïíî-ìîçêîâèõ òðàâìàõ çà
â³äñóòíîñò³ ô³çè÷íèõ ïîðóøåíü òà ïîêðàùóþòü
ìîæëèâîñò³ ñàìîñò³éíîãî æèòòÿ òà ïîâåðíåííÿ äî
ðîáîòè.
Çðîñòຠòåíäåíö³ÿ äî “ðàííüî¿ ãîñòðî¿ ðåàá³ë³-
òàö³¿”. Íåäàâí³ äîñë³äæåííÿ, ùî îö³íþþòü ðàííº
âïðîâàäæåííÿ ðåàá³ë³òàö³¿ â áëîö³ ³íòåíñèâíî¿ òå-
ðàﳿ (Á²Ò), ïðîäåìîíñòðóâàëè ïîêðàùåííÿ ô³çè÷-
íèõ ôóíêö³é òà ÿêîñò³ æèòòÿ, à òàêîæ ïîâòîðíèõ
íàäõîäæåíü äî ë³êàðí³, ³íñòèòóö³îíàë³çàö³¿ òà ñìåðò-
íîñò³, à òàêîæ çìåíøåííÿ òðèâàëîñò³ øòó÷íî¿ âåí-
òèëÿö³¿ ëåãåíü òà òðèâàëîñò³ ïåðåáóâàííÿ â Á²Ò òà
ë³êàðí³ (ÒÏ)30. Åêîíîì³ÿ êîøò³â àáî íåéòðàëüí³
âèòðàòè ìîæóòü áóòè äîñÿãíóò³ çà äîïîìîãîþ ïðî-
ãðàì ðàííüî¿ ðåàá³ë³òàö³¿ ó áëîêàõ ³íòåíñèâíî¿ òå-
ðàﳿ (Á²Ò). ×èòà÷ ñêåðîâóºòüñÿ äî Bailey et al.31
ùîäî ñòðàòå㳿 â³äáîðó õîðîøèõ êàíäèäàò³â íà
ðàííþ ðåàá³ë³òàö³þ äëÿ áîðîòüáè ç ñóïóòí³ìè çàõ-
âîðþâàííÿìè, çäîáóòèìè ó Á²Ò. Ó àêàäåì³÷íèõ
öåíòðàõ òðåòèííîãî ð³âíÿ ãîñòð³ ë³æêà àáî áëîêè
ÔÐÌ ³íîä³ îðãàí³çîâóþòüñÿ ïîáëèçó àáî á³ëÿ
Á²Ò 32,33 .
Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà
ó ï³äãîñòðèõ çàêëàäàõ
Ïàö³ºíòè ³ç (ïîòåíö³éíèì) çàëèøêîâèì îáìå-
æåííÿì æèòòºä³ÿëüíîñò³ ï³ñëÿ ãîñòðîãî çàõâîðþ-
âàííÿ àáî òðàâìè òà/àáî çàëèøêîâèõ ïîòðåáàõ ³
¹2(2) *2018
 ÐÎÇÄ²Ë 8 – ÑÏÅÖ²ÀËÜͲÑÒÜ ÔÐÌ Â ÑÈÑÒÅ̲ ÎÕÎÐÎÍÈ ÇÄÎÐÎÂ’ß ÒÀ ÑÓÑϲËÜÑÒ²
ö³ëÿõ ðåàá³ë³òàö³¿ áóäóòü ñêåðîâàí³ äëÿ ïîäàëüøèõ
³íòåðâåíö³é ÔÐÌ ï³ñëÿ ãîñòðî¿ ôàçè äî ï³äãîñòðî¿
äîïîìîãè ÔÐÌ. Öå ìîæå áóòè ñòàö³îíàðíèé çàê-
ëàä ðåàá³ë³òàö³¿ àáî àìáóëàòîðíèé ï³äðîçä³ë ó
â³ää³ëåíí³ ÔÐÌ34. Ïàö³ºíòè ïîòðàïëÿþòü äî ïðî-
ãðàìè ö³ëü-ñïðÿìîâàíî¿ ìóëüòè-ïðîôåñ³éíî¿ ðåàá³-
ë³òàö³¿ ï³ä â³äïîâ³äàëüí³ñòþ ë³êàðÿ ÔÐÌ. Ïîñëóãè
ÔÐÌ ïîâèíí³ ïëàíóâàòèñü òà íàäàâàòèñü ÷åðåç
ñêîîðäèíîâàí³ ìåðåæ³ (“õàá ³ ñïèö³”), äëÿ îõîïëåí-
íÿ ö³ëîãî êîíòèíóóìó äîïîìîãè, çàñíîâóþ÷èñü íà
ïðîöåñ³ ñîðòóâàííÿ. Ïàö³ºíòó ïîâèíåí áóòè ïðèçíà-
÷åíèé â³äïîâ³äíèé ð³âåíü ðåàá³ë³òàö³éíî¿ äîïîìîãè,
âèõîäÿ÷è ç ðåçóëüòàò³â ñîðòóâàëüíîãî îö³íþâàí-
íÿ çà äîïîìîãîþ ñèñòåìè êëàñèô³êàö³¿ ïàö³ºíò³â
(Ìàëþíîê 1). Ö³ ð³âí³ çàëåæàòü â³ä ñêëàäíîñò³ ïî-
òðåá ³ ö³ëåé ðåàá³ë³òàö³¿, à òàêîæ â³ä çàõâîðþâà-
íîñò³/ïîøèðåíîñò³ ñòàíó çäîðîâ’ÿ: çàãàëüíèé àáî
ïåðâèííèé, ñïåö³àë³çîâàíèé àáî âòîðèííèé òà âèñî-
êîñïåö³àë³çîâàíèé àáî òðåòèííèé ð³âåíü35,36. ϳñëÿ
ñîðòóâàííÿ áóäå âèçíà÷åíà ïðîãðàìà ðåàá³ë³òàö³¿,
´ðóíòîâàíà íà îö³íþâàíí³, à ïîò³ì áóäóòü çä³éñíþ-
âàòèñÿ âòðó÷àííÿ. Äëÿ âèçíà÷åííÿ íîâèõ ö³ëåé, ÿê³
ìàþòü áóòè äîñÿãíóò³ â ðàìêàõ àáî îäí³º¿ ïîñëó-
ãè àáî íà ³íøîìó ð³âí³ äîïîìîãè, ÿêùî öå äîðå÷-
íî, ìຠáóòè ïðîâåäåíà ðåãóëÿðíà îö³íêà. Öåé ïðî-
öåñ, ÿêèé ïîâòîðþºòüñÿ, òàêîæ íàçèâàºòüñÿ
ðåàá³ë³òàö³éíèì öèêëîì (äèâ. Ðîçä³ë 7). Ïàö³ºíòè
ìîæóòü íàäõîäèòè äëÿ ï³äãîñòðî¿ äîïîìîãè ÿêùî:
1) âîíè º äîñòàòíüî ìåäè÷íî ñòàá³ëüíèìè ³ ïðè-
äàòíèìè äëÿ àêòèâíî¿ ó÷àñò³ â ïðîãðàì³ ÔÐÌ,
2) ¿ì ìîæå äîïîìîãòè ìóëüòè-ïðîôåñ³éíèé ï³äõ³ä,
3) ïðèñóòí³ âèçíà÷åí³ ö³ë³, ìîòèâàö³ÿ òà äîñòàòí³é
ïîòåíö³àë äëÿ íàâ÷àííÿ.
˳êàð ÔÐÌ áóäå óòî÷íþâàòè ä³àãíîç, ïîâ³äîì-
ëÿòè ïàö³ºíòà, ðîäèíó òà äîãëÿäà÷³â ùîäî ïðîãíî-
çó òà êåðóâàòè êîìàíäîþ òà ñëóæáîþ ç óñ³õ àñ-
ïåêò³â. ϳäãîñòð³ çàêëàäè áóäóòü íàäàâàòè
äîïîìîãó ïåðåâàæíî ïàö³ºíòàì ç³ ñòàíàìè ç ðàï-
Ìàëþíîê 1. Ñòðàòèô³êîâàíà ìîäåëü ðåàá³ë³òàö³¿93
ÑÊÏ: ñèñòåìà êëàñèô³êàö³¿ ïàö³ºíò³â
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
òîâèì ïî÷àòêîì. Îäíàê ïðîòÿãîì ôàç ³ç çì³íîþ
ïîòðåá öå ìîæå áóòè êîðèñíèì äëÿ ïàö³ºíò³â ç ïå-
ð³îäè÷íèìè, ïðîãðåñóþ÷èìè àáî ñòàá³ëüíèìè ñòà-
íàìè.
Ïðîòÿãîì ï³äãîñòðèõ ðåàá³ë³òàö³éíèõ ïîñëóã
ë³êàð ÔÐÌ áóäå äáàòè ïðî êîìïëåêñíèé ïðîöåñ
ðåàá³ë³òàö³¿34. Öå âêëþ÷ຠïðîäîâæåííÿ ë³êóâàííÿ
îñíîâíîãî ñòàíó çäîðîâ’ÿ òà/àáî íàñë³äê³â îïåðàö³¿
àáî ³íøèõ ³íâàçèâíèõ âòðó÷àíü, à òàêîæ òðåíóâàí-
íÿ ôóíêö³é îðãàí³çìó òà àêòèâíîñòåé. Ïðîòÿãîì
ï³äãîñòðî¿ ôàç³, ïëàíóâàííÿ òà ï³äãîòîâêà äî ðå³í-
òåãðàö³¿ â ñóñï³ëüñòâî âñå á³ëüøå ³ á³ëüøå ïåðåñó-
âàºòüñÿ íà ïåðåäí³é ïëàí. Öå âêëþ÷ຠñàìîñò³éíå
æèòòÿ, ïðàöåâëàøòóâàííÿ, îñâ³òó òà ³íø³ ñôåðè
ó÷àñò³. Öå òàêîæ îçíà÷ຠðîáîòó ç ðîäèíàìè, ñîö³-
àëüíèìè ñëóæáàìè òà ðîáîòîäàâöÿìè, à òàêîæ
íàâ÷àííÿ òà îñâ³òó ïàö³ºíòà.
Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà ó
äîâãîòðèâàëèõ çàêëàäàõ
ϳñëÿ ïåð³îäó ï³äãîñòðî¿ äîïîìîãè, íåçàëåæíî
â³ä ñòàö³îíàðíîãî ÷è àìáóëàòîðíîãî áàçóâàííÿ,
äåÿê³ ïàö³ºíòè ìîæóòü ïîòðåáóâàòè äîâãîòðèâàëî¿
äîïîìîãè. Äîâãîòðèâàëà ðåàá³ë³òàö³ÿ – öå äîïîìî-
ãà, ùî íàäàºòüñÿ ïðîòÿãîì äîâãîòðèâàëîãî ïåð³î-
äó ÷àñó îñîáàì, ÿê³ çàçíàþòü äîâãîòðèâàëîãî îá-
ìåæåííÿ æèòòºä³ÿëüíîñò³ àáî òðóäíîù³â ó
ôóíêö³îíóâàíí³. Äîâãîòðèâàëà äîïîìîãà òàêîæ
ìîæå áóòè ïîâ’ÿçàíà ç õðîí³÷íèì çàõâîðþâàí-
íÿì37. Äîâãîòðèâàë³ ðåàá³ë³òàö³éí³ ïîñëóãè ìîæóòü
íàäàâàòèñÿ ó ôîðì³ ïåðåðèâ÷àñòî¿ ñòàö³îíàðíî¿
äîïîìîãè àáî áåçïåðåðâíî¿ àìáóëàòîðíî¿/â ãðî-
ìàä³ / äîìàøíüî¿ ðåàá³ë³òàö³¿.
Ïðè äîâãîòðèâàë³é äîïîìîç³ ÔÐÌ ìîæå íàäà-
âàòè áàãàòî âàæëèâèõ ðåàá³ë³òàö³éíèõ ïîñëóã.
Ñïåêòð ïîøèðþºòüñÿ â³ä áåçïåðåðâíîãî ìîí³òîðèí-
ãó ôóíêö³îíóâàííÿ òà îáìåæåíü æèòòºä³ÿëüíîñò³,
äîâãîòðèâàëî¿ ìåäèêàìåíòîçíî¿ òåðàﳿ, ïðèçíà÷åí-
íÿ âòðó÷àíü (íàïð. ô³çè÷íà òåðàï³ÿ, åðãîòåðàï³ÿ,
òåðàï³ÿ ìîâè òà ìîâëåííÿ àáî (íåéðîïñèõîëîã³ÿ)
àáî íàäàííÿ äîïîì³æíèõ ïðèñòðî¿â). ˳êàð³ ÔÐÌ
òàêîæ íàâ÷åí³ äàâàòè ïîðàäè ïàö³ºíòàì, ðîäèíàì
òà äîãëÿäà÷àì, à òàêîæ ðîáîòîäàâöÿì òà ³íøèì
ñóñï³ëüíèì ³íñòèòóö³ÿì. ÔÐÌ ïîâèííà áðàòè ó÷àñòü
ó ïðîãðàìàõ ðåàá³ë³òàö³¿, ùî íàäàºòüñÿ â ãðîìàä³,
íàïð. ÿê êîíñóëüòàíò òà/àáî òðåíåð ïðàö³âíèê³â
ðåàá³ë³òàö³¿, ùî íàäàºòüñÿ â ãðîìàäè. ˳êàð³ ÔÐÌ
ìîæóòü ï³äòðèìóâàòè ë³êàð³â çàãàëüíî¿ ïðàêòèêè
òà ³íøèõ ìåäè÷íèõ ñïåö³àë³ñò³â øëÿõîì êîíñóëü-
òàö³é òà/àáî êîîðäèíàö³¿ ðåàá³ë³òàö³éíèõ ìåðåæ. Öå
îñîáëèâî âàæëèâî äëÿ ð³çí³ çàõâîðþâàíü àáî
îáìåæåíü æèòòºä³ÿëüíîñò³ â³äïîâ³äíî.
Ó äîâãîòðèâàë³é ôàç³ äîïîìîãè ÔÐÌ îñîáëèâèé
àêöåíò çîñåðåäæåíèé íà çàõîäàõ ï³äòðèìêè òà
153
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
âòîðèííî¿ ïðîô³ëàêòèêè, àëå öå áóäå äîäàòêîâî
ïîÿñíåíî â íàñòóïíèõ ðîçä³ëàõ.
Íàñòóïíèé êë³í³÷íèé âèïàäîê íàâîäèòü ïðèêëàä
ïàö³ºíòà âïðîäîâæ ð³çíèõ ôàç ïðîöåñó ÔÐÌ:
Êë³í³÷íèé âèïàäîê ïàö³ºíòà ç âòðàòîþ
ê³íö³âîê
55-ð³÷íèé ÷îëîâ³ê ñòðàæäຠõðîí³÷íèì îñòåî-
쳺ë³òîì ³ â³äêðèòèìè ðàíàìè ë³âî¿ ï’ÿòêè, ï³ñëÿ
àâà𳿠íà àâòîìîá³ë³ ï’ÿòü ðîê³â òîìó. Áóëè ïðîâå-
äåí³ íåîäíîðàçîâ³ õ³ðóðã³÷í³ òà ìåäè÷í³ âòðó÷àí-
íÿ, àëå íå â³äáóëîñÿ çàãîºííÿ, òà ÿê³ñòü éîãî æèò-
òÿ ñåðéîçíî ïîðóøèëàñÿ. Çà 3 ðîêè â³í ïåðåñòàâ
ïðàöþâàòè òåõí³êîì. ³í áóâ ñêåðîâàíèé äî ë³êà-
ðÿ ÔÐÌ äëÿ êîíñóëüòóâàííÿ ùîäî ìîæëèâî¿ àì-
ïóòàö³¿. ϳñëÿ ìóëüòèäèñöèïë³íàðíîãî îö³íþâàííÿ
ðåêîìåíäîâàíà òðàíñòèá³àëüíà àìïóòàö³ÿ, ³ ïàö³ºíò
ïîòðàïëÿº äî ïðîãðàìè ïðåàá³ë³òàö³¿, ÿêà âêëþ÷àº
ðåêîíäèö³îíóâàííÿ, çá³ëüøåííÿ ñèëè ïðàâî¿ íèæíüî¿
òà îáîõ âåðõí³õ ê³íö³âîê, õîä³ííÿ ç ìèëèöÿìè òà
íàâ÷àëüíó ïðîãðàìó. ×åðåç äâà ì³ñÿö³ ïðîâåäåíà
àìïóòàö³ÿ, ï³ñëÿ ÷îãî â³äáóâàºòüñÿ íåãàéíà ï³ñëÿ-
îïåðàö³éíà ðåàá³ë³òàö³ÿ áåç ïðîòåçóâàííÿ (“ãîñòðà
ðåàá³ë³òàö³ÿ”). ϳñëÿ âèïèñêè â³äáóâàºòüñÿ ï³äãî-
ñòðå ñïîñòåðåæåííÿ, à çà äâà ì³ñÿö³ çä³éñíþºòüñÿ
4-õ òèæíåâà ñòàö³îíàðíà ðåàá³ë³òàö³éíà ïðîãðàìà
ï³ñëÿ ï³äáîðó ïðîòåçó (“ï³äãîñòðà ðåàá³ë³òàö³ÿ”). Çà
äâà ì³ñÿö³ ï³ñëÿ îö³íþâàííÿ ïàö³ºíò ìîæå êåðóâà-
òè ñâîºþ ìàøèíîþ òà ïîâåðíóòèñÿ äî ðîáîòè. Íà
äîâãîòðèâàë³é îñíîâ³ îðãàí³çóºòüñÿ ïðîâåäåííÿ
ùîð³÷íèõ ñïîñòåðåæåíü äëÿ êàë³áðóâàííÿ òà ïîíîâ-
ëåííÿ ïðîòåçó (“äîâãîòðèâàëà ôàçà”).
Âèñíîâêè
Çàëåæíî â³ä òèïó ñòàíó çäîðîâ’ÿ òà ïîòðåá
ôóíêö³îíóâàííÿ, ïðîöåñ ÔÐÌ âêëþ÷àòèìå ð³çí³
ôàçè. Ðåãóëÿðíå ïåðåîö³íþâàííÿ òà ñîðòóâàííÿ ç
ñêåðóâàííÿì ïàö³ºíòà äî â³äïîâ³äíîãî ð³âíÿ òà çàê-
ëàäó ðåàá³ë³òàö³éíî¿ äîïîìîãè º îáîâ’ÿçêîâèì.
Òîìó ðåàá³ë³òàö³éí³ ïîñëóãè ïîâèíí³ áóòè ñòðàòè-
ô³êîâàí³ òà îðãàí³çîâàí³ â ìåðåæ³ äëÿ çàáåçïå÷åí-
íÿ íàéêðàùî¿ äîïîìîãè, àäàïòîâàíî¿ äî ïîòðåá òà
ö³ëåé îñîáè, ïðîòÿãîì êîíòèíóóìó äîïîìîãè.
Ïðîô³ëàêòèêà, ï³äòðèìêà çäîðîâ’ÿ
òà çì³öíåííÿ çäîðîâ’ÿ ó ô³çè÷í³é
òà ðåàá³ë³òàö³éí³é ìåäèöèí³
Ó ë³òåðàòóð³ òåðì³íè «ïðîô³ëàêòèêà», «ï³äòðèì-
êà çäîðîâ’ÿ» òà «çì³öíåííÿ çäîðîâ’ÿ» ÷àñòî âèêî-
ðèñòîâóþòüñÿ âçàºìîçàì³ííî, à ïîâ’ÿçàí³ ç öèì 䳿
ñóòòºâî ïåðåêðèâàþòüñÿ (íàïð. ô³çè÷íà àê-
òèâí³ñòü àáî çäîðîâà ¿æà). Òîìó âîíè ðîçãëÿäà-
þòüñÿ â îäíîìó ðîçä³ë³. Íåìຠ÷³òêîãî êîíñåíñó-
ñó ùîäî â³äïîâ³äíèõ âèçíà÷åíü. ϳñëÿ çàãàëüíîãî
154 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ââåäåííÿ äëÿ âèçíà÷åííÿ ð³çíèö³ òåðì³í³â, ð³çí³
òåìè áóäóòü ðîçãëÿäàòèñÿ ç òî÷êè çîðó ÔÐÌ.
Çäîðîâ’ÿ ìîæíà ðîçãëÿäàòè, ÿê êîíòèíóóì ç
íåéòðàëüíèì çäîðîâ’ÿì âñåðåäèí³, íåãàòèâíèì
çäîðîâ’ÿì (õâîðîáîþ) ë³âîðó÷ òà ïîçèòèâíèì çäî-
ðîâ’ÿì (áëàãîïîëó÷÷ÿ) ïðàâîðó÷, ³ â³äïîâ³äíî
â³äíîñèòüñÿ äî êîæíî¿ ç öèõ òðüîõ êîíöåïö³é38.
Ïðîô³ëàêòèêà õâîðîá âêëþ÷ຠ䳿, ùî ñïðÿìî-
âàí³ íà çìåíøåííÿ àáî óñóíåííÿ ðèçèê³â, ùî ìî-
æóòü çá³ëüøèòè øàíñè ëþäèíè àáî ãðóïè çàçíàòè
õâîðîáó, îáìåæåííÿ æèòòºä³ÿëüíîñò³ àáî ïåðåä-
÷àñíó ñìåðòü. Ïåðâèííà ïðîô³ëàêòèêà â³äíîñèòü-
ñÿ äî çàõîä³â, ñïðÿìîâàíèõ íà çàïîá³ãàííÿ àáî
óñóíåííÿ ïðè÷èíè ïðîáëåìè çäîðîâ’ÿ ó îñîáè àáî
ïîïóëÿö³¿ ïåðåä ¿¿ âèíèêíåííÿì3. Âòîðèííà ïðî-
ô³ëàêòèêà âêëþ÷ຠçàõîäè äëÿ âèÿâëåííÿ ïðîáëå-
ìè çäîðîâ’ÿ íà ðàíí³é ñòà䳿 ó ëþäèíè àáî ïîïó-
ëÿö³¿, ñïðèÿþ÷è ë³êóâàííþ, çìåíøåííþ ÷è
çàïîá³ãàííþ ïîøèðåííÿ, àáî çìåíøåííþ ÷è çàïî-
á³ãàííþ ¿¿ äîâãîòðèâàëèì íàñë³äêàì3. Òðåòèííà
ïðîô³ëàêòèêà ñïðÿìîâàíà íà çìåíøåííÿ âïëèâó
çàõâîðþâàííÿ, ÿêå âæå ïî÷àëîñü, øëÿõîì â³äíîâ-
ëåííÿ ôóíêö³¿ òà çìåíøåííÿ óñêëàäíåíü, ùî ïîâ’ÿ-
çàí³ ³ç çàõâîðþâàííÿì3.
ϳäòðèìêà çäîðîâ’ÿ â³äíîñèòüñÿ äî ï³äòðèìêè
ð³âíÿ ñòàá³ëüíîãî ñòàíó çäîðîâ’ÿ òà ìàêñèìàëüíî¿
ôóíêö³¿, íàïð. øëÿõîì ñêðèí³íãó, ïîâàãè äî çäîðî-
âîãî ñïîñîáó æèòòÿ òà ï³êëóâàííÿ ïðî ïñèõîñîö³-
àëüí³ òà äóõîâí³ ïðîáëåìè39.
Êîëè º ïðèñóòíüîþ ñòàá³ëüí³ñòü çäîðîâ’ÿ, ïî-
ë³ïøåííÿ çäîðîâ’ÿ òà áëàãîïîëó÷÷ÿ ìîæå áóòè äî-
ñÿãíóòî øëÿõîì çì³öíåííÿ çäîðîâ’ÿ: ðîçâèòîê ïî-
âåä³íêè, ùî ïîë³ïøóº ôóíêö³îíóâàííÿ îðãàí³çìó òà
ïîêðàùóº çäàòí³ñòü ëþäèíè àäàïòóâàòèñÿ äî ñå-
ðåäîâèùà, ÿêå çì³íþºòüñÿ. Çì³öíåííÿ çäîðîâ’ÿ
âèçíà÷àºòüñÿ ÂÎÎÇ ÿê ïðîöåñ, ùî äîçâîëÿº ëþ-
äÿì çá³ëüøóâàòè êîíòðîëü íàä ñâî¿ì çäîðîâ’ÿì òà
éîãî äåòåðì³íàíòàìè, à îòæå, ³ ïîë³ïøèòè ñâîº
çäîðîâ’ÿ40. Òàêèì ÷èíîì, çì³öíåííÿ çäîðîâ’ÿ äî-
ïîìàãຠëþäÿì ðóõàòèñÿ âãîðó ïî êîíòèíóóìó
çäîðîâ’ÿ.
Ïðîô³ëàêòèêà, ï³äòðèìêà çäîðîâ’ÿ
òà çì³öíåííÿ çäîðîâ’ÿ, ïîâ’ÿçàí³
ç ô³çè÷íîþ òà ðåàá³ë³òàö³éíîþ ìåäèöèíîþ
Ðîáîòà ë³êàð³â ÔÐÌ çîñåðåäæóºòüñÿ ñåðåä
³íøèõ ïèòàíü íà ñòðàòå㳿, ñïðÿìîâàíî¿ íà óìîæ-
ëèâëåííÿ ëþäåé ç õðîí³÷íèìè çàõâîðþâàííÿìè òà
äîâãîòðèâàëèìè àáî âæå ³ñíóþ÷èìè îáìåæåííÿ-
ìè æèòòºä³ÿëüíîñò³, äîñÿãòè ìàêñèìàëüíî ìîæëè-
âîãî âèñîêîãî ð³âíÿ çäîðîâ’ÿ òà ÿêîñò³ æèòòÿ ÷å-
ðåç çóñèëëÿ ùîäî çì³öíåííÿ çäîðîâ’ÿ òà ñòðàòåã³é
ïðîô³ëàêòèêè òà ï³äòðèìêè. Çàõîäè ùîäî çì³öíåííÿ
çäîðîâ’ÿ, ñïðÿìîâàí³ íà îñ³á ç îáìåæåííÿìè æèò-
òºä³ÿëüíîñò³, ìîæóòü ìàòè ñóòòºâèé âïëèâ íà ïî-
¹2(2) *2018
 ÐÎÇÄ²Ë 8 – ÑÏÅÖ²ÀËÜͲÑÒÜ ÔÐÌ Â ÑÈÑÒÅ̲ ÎÕÎÐÎÍÈ ÇÄÎÐÎÂ’ß ÒÀ ÑÓÑϲËÜÑÒ²
êðàùåííÿ òðàäèö³é ñïîñîáó æèòòÿ, ï³äâèùåííÿ
ÿêîñò³ æèòòÿ òà çíèæåííÿ ìåäè÷íèõ âèòðàò41.
ϳäòðèìêà àáî ïîë³ïøåííÿ çäîðîâ’ÿ ìîæå áóòè
ñêëàäí³øîþ äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³, îñê³ëüêè âîíè ìàþòü ï³äâèùåíèé ðèçèê âèíèê-
íåííÿ íèçêè ô³çè÷íèõ, ïñèõîëîã³÷íèõ, ñîö³àëüíèõ òà
åìîö³éíèõ ïðîáëåì, ÿê³ çãàäóþòüñÿ â îïóáë³êîâàí³é
ë³òåðàòóð³, ÿê âòîðèíí³ ñòàíè. Ö³ ñòàíè, ÿê âèäàºòü-
ñÿ, ìàþòü ãëèáîêèé íåãàòèâíèé âïëèâ íà çäîðîâ’ÿ
òà ôóíêö³þ ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³, ³ â ñóêóïíîñò³ ïîòåíö³éíî ìîæóòü ñóòòºâî îá-
ìåæèòè ó÷àñòü ó çàãàëüí³é àêòèâíîñò³42.
Çàïîá³ãàííÿ àáî óïðàâë³ííÿ âòîðèííèìè ñòàíà-
ìè, ôàêòîðàìè ðèçèêó òà âïëèâ íà çì³íí³, ùî ïî-
â’ÿçàí³ ç îäíèì àáî äâîìà ôàêòîðàìè, º âàæëèâèì
ïð³îðèòåòîì3. Äåê³ëüêà ïåðåõðåñíèõ äîñë³äæåíü
ïîâ³äîìëÿëè ïðî íàÿâí³ñòü â ñåðåäíüîìó â³ä 4 äî
13 âòîðèííèõ ñòàí³â ó ëþäåé ç ô³çè÷íèìè òà êîãí³-
òèâíèìè îáìåæåííÿìè æèòòºä³ÿëüíîñò³43-45. Íå-
çâàæàþ÷è íà òå, ùî áàãàòî ç öèõ ñòàí³â (íàïð. á³ëü,
ñëàáê³ñòü, çá³ëüøåííÿ ìàñè ò³ëà, äåïðåñ³ÿ) òàêîæ
çóñòð³÷àþòüñÿ ó îñ³á áåç îáìåæåíü æèòòºä³ÿëü-
íîñò³, îáñòàâèíàìè, ÿê³ ðîáëÿòü ¿õ óí³êàëüíèìè äëÿ
îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà ñòàíàìè
çäîðîâ’ÿ, ÿê³ ìîæóòü ïðèçâåñòè äî îáìåæåíü æèò-
òºä³ÿëüíîñò³, º òå, ùî âîíè çóñòð³÷àþòüñÿ ³ç çíà÷-
íî á³ëüøîþ ÷àñòîòîþ ÿê ó ä³òåé, òàê ³ ó äîðîñëèõ
ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³. Öÿ á³ëüø âèñîêà
÷àñòîòà º îäíèì ³ç êðèòåð³¿â, ÿêèé âèêîðèñòîâóºòü-
ñÿ ïðè âèçíà÷åíí³ ñòàíó, ÿê âòîðèííîãî ñòàíó46.
Àëãîðèòì ïðèéíÿòòÿ ð³øåíü ùîäî ìåíåäæìåíòó
âòîðèííèõ ñòàí³â ïî÷èíàºòüñÿ ç ³äåíòèô³êàö³¿ òà êå-
ðóâàííÿ ôàêòîðàìè ðèçèêó (íàïð. ïåðâèííîãî ñòàíó,
ùî ôîðìóº ïåðåäóìîâè ó ³íäèâ³äà äî âòîðèííîãî
ñòàíó) ³ ïðîäîâæóºòüñÿ ç íàñòóïíèì ìåíåäæìåíòîì
(íàïð. ÷åðåç âòðó÷àííÿ) âòîðèííîãî ñòàíó46. ³í
îõîïëþº ïî÷àòîê ³ ïåðåá³ã âòîðèííèõ ñòàí³â (íåçì³íí³
ïîïåðåäí³ äàí³ òà ôàêòîðè ðèçèêó, ùî ìîäèô³êóþòü-
ñÿ) òà âèçíà÷ຠðåçóëüòàòè, ïîâ’ÿçàí³ ç âòîðèííèìè
ñòàíàìè, íà ð³âíÿõ îñîáè òà ñóñï³ëüñòâà.
Íåçì³ííèìè ïîïåðåäí³ìè äàíèìè º ñîö³àëüíî-
äåìîãðàô³÷í³ ôàêòîðè, íàÿâí³ ðàí³øå ñòàíè, ôàê-
òîðè, ïîâ’ÿçàí³ ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà
àñîö³éîâàí³ ñòàíè.
Ôàêòîðè ðèçèêó, ùî ìîäèô³êóþòüñÿ, ïîä³ëÿþòü-
ñÿ íà îñîáèñò³ ôàêòîðè òà ôàêòîðè ñåðåäîâèùà.
Îñîáèñò³ ôàêòîðè ðèçèêó âêëþ÷àþòü ïîâåä³íêó,
òàêó, ÿê çëîâæèâàííÿ àáî íåâæèâàííÿ, çíèæåíó àáî
â³äñóòíþ ô³çè÷íó àêòèâí³ñòü, ïîãàíó 䳺òó, ïîãàíå
âèêîðèñòàííÿ ë³ê³â, íåäîñòàòíþ ó÷àñòü ó ðåàá³ë³-
òàö³¿ òà çá³ëüøåííÿ âèêîðèñòàííÿ ðå÷îâèí (íàïð.
òþòþíó, àëêîãîëþ, ïðèçíà÷åíèõ ë³ê³â òà çàáîðîíå-
íèõ íàðêîòèê³â). Ôàêòîðè ñåðåäîâèùà âêëþ÷àþòü
çìåíøåíó ÷è íèçüêîÿê³ñíó äîïîìîãó â ñôåð³ îõî-
ðîíè çäîðîâ’ÿ, çìåíøåííÿ äîñòóïó äî ïîáóäîâà-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
íîãî ñåðåäîâèùà, ïîãàíèé äîñòóï äî çì³öíåííÿ
çäîðîâ’ÿ (íàïð. â³äñóòí³ñòü òðàíñïîðòóâàííÿ äî
ïðîãðàì çì³öíåííÿ çäîðîâ’ÿ ó ãðîìàäàõ), à òàêîæ
îáìåæåíó àáî â³äñóòíþ ñîö³àëüíó ï³äòðèìêó.
Êð³ì òîãî, íåîáõ³äíî âðàõîâóâàòè ñîö³àëüí³ òà
åêîëîã³÷í³ áàð’ºðè, ÿê³ çàâàæàþòü äîðîñëèì ç îá-
ìåæåííÿìè æèòòºä³ÿëüíîñò³ ïðèéìàòè á³ëüø çäî-
ðîâèé ñïîñ³á æèòòÿ òà ïîë³ïøåííÿ çäîðîâ’ÿ47.
Ïðîô³ëàêòèêà çàõâîðþâàíü ó ô³çè÷í³é
òà ðåàá³ë³òàö³éí³é ìåäèöèí³
ßê çãàäóâàëîñÿ âèùå, ïðîô³ëàêòèêà çàõâîðþ-
âàíü êëàñèô³êóºòüñÿ ÿê ïåðâèííà, âòîðèííà àáî
òðåòèííà.
Ìåäè÷íà ðåàá³ë³òàö³ÿ òðàäèö³éíî ðîçãëÿäàºòü-
ñÿ ÿê ñòðàòåã³ÿ òðåòèííî¿ ïðîô³ëàêòèêè48, àëå ë³êàð³
ÔÐÌ ìîæóòü áóòè çàëó÷åí³ äî ïðîô³ëàêòèêè çàõ-
âîðþâàíü àáî òðàâì íà âñ³õ ð³âíÿõ.
˳êàð ÔÐÌ â³ä³ãðຠâàæëèâó ðîëü ïðè ïåðâèíí³é
ïðîô³ëàêòèö³ çà äîïîìîãîþ ð³çíèõ ñòèìóë³â ó ñôåð³
ÔÐÌ (íàïð. ô³çè÷íà òåðàï³ÿ àáî ô³çè÷í³ âïðàâè),
ùî ìîæå çíà÷íî ïîêðàùèòè ìåõàí³çìè ðåãóëþâàí-
íÿ ïðàêòè÷íî âñ³õ ñèñòåì îðãàí³â. Ïåðåâàãà ìîæå
áóòè äîñÿãíóòà øëÿõîì çàòðèìêè àáî ïðîô³ëàêòè-
êè çàõâîðþâàíîñò³ ÷èñëåííèõ õðîí³÷íèõ çàõâîðþ-
âàíü, íàïð. ñåðöåâî-ñóäèííèõ, òàêèõ ÿê ã³ïåðòîí³ÿ
³ àòåðîñêëåðîç, ìåòàáîë³÷íèõ, íàïð. ìåòàáîë³÷íèé
ñèíäðîì àáî ì’ÿçîâî-ñêåëåòíèõ, íàïð. îñòåîïî-
ðîç. Ô³çè÷íà àêòèâí³ñòü ïîâ’ÿçàíà ç³ çíèæåííÿì
ðèçèê³â áàãàòüîõ âèä³â ðàêó49.
ßê ïðîïîíóºòüñÿ â ³í³ö³àòèâ³ “Ïðèçíà÷åííÿ ô³çè÷-
íèõ âïðàâ äëÿ çäîðîâ’ÿ” European Federation of
Sports Medicine Associations (EFSMA), ô³çè÷íà àê-
òèâí³ñòü òà ô³çè÷í³ âïðàâè ïîâèíí³ áóòè ñòàíäàðò-
íèìè êîìïîíåíòàìè ïðîô³ëàêòèêè õâîðîá òà ìåäè÷-
íîãî ë³êóâàííÿ, ³ çàêëèêàþòü íàäàâà÷³â ïîñëóã â
îõîðîí³ çäîðîâ’ÿ îö³íþâàòè òà ïåðåãëÿäàòè ïðîãðà-
ìè ô³çè÷íî¿ àêòèâíîñò³ ïàö³ºíò³â ïðè êîæíîìó â³çèò³.
Òàêîæ ó Lancet îñòàíí³ì ÷àñîì áóëî îïóáë³êîâàíî
çàêëèê ùîäî ðîçøèðåííÿ ³íòåðâåíö³¿ ç ô³çè÷íî¿ àê-
òèâíîñò³ ïî âñüîìó ñâ³òîâ³, çàäëÿ ñïðèÿííÿ ïîãëèá-
ëåííþ á³ëüø øèðîêèõ ³ ðîçóìíèõ ï³äõîä³â äî ðóõó
ëþäåé50. Äîäàòêîâî äî çàõâîðþâàíîñò³ òà ïåðåä-
÷àñíî¿ ñìåðòíîñò³, ô³çè÷íà íå àêòèâí³ñòü º â³äïîâ³-
äàëüíîþ çà çíà÷íå åêîíîì³÷íå íàâàíòàæåííÿ51.
Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà òàêîæ
â³ä³ãðຠâàæëèâó ðîëü ó çàïîá³ãàíí³ ïîïåðåêîâîãî
òà øèéíîãî áîëþ, ïîðóøåííÿõ êðîâîîá³ãó òà ìå-
òàáîë³çìó, à òàêîæ ó çàïîá³ãàíí³ ñêàðã, ïîâ’ÿçàíèõ
ç ðîáîòîþ. ²ñíóº øèðîêèé ñïåêòð ïðîô³ëàêòè÷íèõ
çàõîä³â, ùî çàñòîñîâóþòüñÿ ë³êàðÿìè ÔÐÌ, òàêèõ,
ÿê ïðîãðàìè àåðîáíèõ âïðàâ, òðåíóâàííÿ ì’ÿç³â òà
áàëàíñó, øêîëà ïîïåðåêó, ïðîãðàìè ùîäî ïðîô³ëàê-
òèêè ïðè ïðîôåñ³éí³é ä³ÿëüíîñò³, îñâ³òà òà ïîðàäè
ùîäî çäîðîâî¿ ïîâåä³íêè52. Ó ëþäåé ë³òíüîãî â³êó
155
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ïðîãðàìà ÔÐÌ òàêîæ ìîæå çàïîá³ãòè ïàä³ííÿì òà
íåçàëåæíîñò³ õâîðèõ53. Ñòîñîâíî äîðîæíüî-òðàíñ-
ïîðòíèõ ïðèãîä, ë³êàð³ ÔÐÌ ìîæóòü, íàïðèêëàä,
ï³äòðèìóâàòè ïðîìîö³þ âèêîðèñòàííÿ øîëîìà ï³ä
÷àñ ¿çäè íà âåëîñèïåä³.
Ó îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ ïåðâèí-
íà ïðîô³ëàêòèêà âêëþ÷ຠçóñèëëÿ, ñïðÿìîâàí³ íà
çàïîá³ãàííÿ ïîã³ðøåííÿ ïîðóøåíü, ³ ìຠâêëþ÷àòè
â³äïîâ³äí³ ñïåö³àëüí³ çàõîäè äëÿ óñóíåííÿ ôàêòîð³â
ðèçèêó õðîí³÷íèõ ñòàí³â48.
Âòîðèííà ïðîô³ëàêòèêà çà äîïîìîãîþ ô³çè÷íèõ
òåðàïåâòè÷íèõ ìîäàëüíîñòåé º ïðèêëàäîì ó âèïàäêó
ðåãóëÿòîðíèõ ðîçëàä³â àðòåð³àëüíîãî òèñêó, áîëþ ó
ñïèí³ àáî îñòåîïîðîçó. Ïðè ã³ïåðòîí³¿ ôóíêö³îíàëü-
íà àäàïòàö³ÿ ìîæå ïðèçâåñòè äî ïîë³ïøåííÿ ðåãó-
ëÿòîðíèõ ìåõàí³çì³â, ÿê³ ìîæóòü çàïîá³ãòè, àáî,
ïðèíàéìí³, çàòðèìàòè íàñòàííÿ êë³í³÷íî âèðàæåíî¿
ã³ïåðòîí³¿. Ïåðøà ë³í³ÿ ë³êóâàííÿ àðòåð³àëüíî¿ ã³ïåð-
òåí糿 – öå çì³íè ñïîñîáó æèòòÿ, âêëþ÷àþ÷è ô³çè÷í³
âïðàâè. Ïðè âòîðèíí³é ïðîô³ëàêòèö³ áîëþ â ñïèí³
âàæëèâó ðîëü ìîæå â³ä³ãðàòè çì³öíåííÿ ì’ÿç³â òà
âäîñêîíàëåííÿ ìîäåëåé ðóõ³â. Ïðè îñòåîïîðîç³ âàæ-
ëèâî çàïîá³ãàòè äåãðàäàö³¿ ê³ñòîê íàâàíòàæóâàëü-
íîþ äîçîþ ô³çè÷íî¿ àêòèâíîñò³54. Ïðîãðàìè ñåðöå-
âî¿ ðåàá³ë³òàö³¿ / âòîðèííî¿ ïðîô³ëàêòèêè ââàæàþòüñÿ
ñòàíäàðòîì äîïîìîãè òà íàäàþòü êðèòè÷íî âàæëèâ³
ðåñóðñè äëÿ îïòèì³çàö³¿ äîïîìîãè ïàö³ºíòàì ç ñåð-
öåâî-ñóäèííèìè çàõâîðþâàííÿìè55. ²ñíóþòü ïåðå-
êîíëèâ³ äîêàçè äëÿ ðåàá³ë³òàö³éíèõ âòðó÷àíü íà
ï³äòðèìêó ³íòåíñèâíîãî òà ÷àñòî ïîâòîðþâàíîãî,
ö³ëü-ñïðÿìîâàíîãî ³ çàâäàííÿ-ñïåöèô³÷íîãî òðåíó-
âàííÿ íà âñ³õ åòàïàõ ï³ñëÿ ³íñóëüòó56. Âòðó÷àííÿ â
ìåäè÷í³é ðåàá³ë³òàö³¿, ùî ñïðÿìîâàí³ íà ïîñèëåííÿ
àêòèâíîñò³, òàê³, ÿê íàäàííÿ äîïîì³æíèõ òåõíîëîã³é,
ìîæóòü ââàæàòèñÿ âòîðèííîþ ïðîô³ëàêòèêîþ48.
Äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ àáî
ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâîäÿòü äî îáìåæåíü
æèòòºä³ÿëüíîñò³, òðåòèííà ïðîô³ëàêòèêà ïðèçíà÷å-
íà äëÿ çìåíøåííÿ îáìåæåíü ó÷àñò³ îñîáè â ïåâí³é
îáëàñò³ øëÿõîì íàäàííÿ ñïðèÿòëèâîãî ÷èííèêà
àáî øëÿõîì óñóíåííÿ áàð’ºðó. Ìîäèô³êàö³¿ ñåðå-
äîâèùà, íàäàííÿ ïîñëóã, óñóíåííÿ ô³çè÷íèõ
áàð’ºð³â, çì³íè ó ñîö³àëüíîìó ñòàâëåíí³ òà ðåôîð-
ìè çàêîíîäàâñòâà òà ïîë³òèêè º ñòðàòåã³ÿìè òðå-
òèííî¿ ïðîô³ëàêòèêè48.
Òðåòèííà ïðîô³ëàêòèêà âêëþ÷ຠâ ñåáå ë³êóâàí-
íÿ, ÿê ò³ëüêè õâîðîáà ñòຠñèìïòîìàòè÷íîþ, ùîá
óíèêíóòè óñêëàäíåíü (íàïð. ïðîô³ëàêòèêà òðîìáî-
çó ãëèáîêèõ âåí òà â³äïîâ³äíà ìîá³ë³çàö³ÿ, ùîá
óíèêíóòè ïîøêîäæåíü øê³ðè ó ïàö³ºíò³â ï³ñëÿ
³íñóëüòó). Òðåòèííà ïðîô³ëàêòèêà âêëþ÷ຠòðèâà-
þ÷³ ³íòåðâàëüí³ çóñèëëÿ, ñïðÿìîâàí³ íà ìàêñèì³çà-
ö³þ òà ï³äòðèìêó ôóíêö³îíàëüíèõ çäàòíîñòåé
ïðîòÿãîì æèòòÿ. Òàêèì ÷èíîì, âàæëèâèì º äîâãî-
òðèâàëèé êîíòàêò ç îñîáîþ ç îáìåæåííÿìè æèòòº-
ä³ÿëüíîñò³, àáî ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâîäÿòü
156 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
äî îáìåæåíü æèòòºä³ÿëüíîñò³, äëÿ çàáåçïå÷åííÿ
ðåàá³ë³òàö³¿, ïîêè íå áóäå çàâåðøåíî ïðèðîäíå
â³äíîâëåííÿ òà çàïîá³ãàííÿ ïîäàëüøîãî ðîçâèòêó
óñêëàäíåíü, ÿêèõ ìîæíà óíèêíóòè.
Áàãàòî òèõ, ùî âèæèëè ï³ñëÿ âàæêèõ õâîðîá,
çàçíàþòü çíà÷íîãî ô³çè÷íîãî, ïñèõîëîã³÷íîãî òà
êîãí³òèâíîãî äåô³öèòó, îñîáëèâî ó âèïàäêó òðèâà-
ëîãî ë³æêîâîãî ðåæèìó. Íîâ³ äîñë³äæåííÿ ï³äòðè-
ìóþòü âêëþ÷åííÿ ïðîãðàì ô³çè÷íî¿ àêòèâíîñò³ òà
ðóõëèâîñò³ äî ïîâñÿêäåííèõ ïðîöåäóð äëÿ ïàö³ºíò³â
ó â³ää³ëåííÿõ ³íòåíñèâíî¿ òåðàﳿ, ÿê òðåòèííî¿
ïðîô³ëàêòèêè57.
Óïðàâë³ííÿ çäîðîâ’ÿì ó ô³çè÷í³é
òà ðåàá³ë³òàö³éí³é ìåäèöèí³
ϳäòðèìêà òà çàáåçïå÷åííÿ òàêîæ º ÷àñòèíîþ
ñôåðè êîìïåòåíòíîñòåé ô³çè÷íî¿ òà ðåàá³ë³òàö³é-
íî¿ ìåäèöèíè. Öå ìຠâåëèêå çíà÷åííÿ äëÿ ë³òí³õ
ïàö³ºíò³â, àëå òàêîæ ïðè õðîí³÷íèõ ñòàíàõ, òàêèõ
ÿê õðîí³÷íèé á³ëü, ñïèííî-ìîçêîâà òðàâìà, àìïó-
òàö³¿, ÷åðåïíî-ìîçêîâà òðàâìà òà áàãàòî ³íøèõ.
Âòðó÷àííÿ ç ï³äòðèìêè º íåîáõ³äíèìè äëÿ çàïîá³-
ãàííÿ âòðàò³ äîñÿãíóòîãî ôóíêö³îíàëüíîãî ð³âíÿ
ï³ñëÿ á³ëüø ³íòåíñèâíî¿ ðåàá³ë³òàö³éíî¿ ôàçè.
Âòðó÷àííÿ ç ï³äòðèìêè â ÔÐÌ ñïðÿìîâàí³ íà
ï³äòðèìêó ìàêñèìàëüíî¿ ôóíêö³¿ òà óíèêíåííÿ óñ-
êëàäíåíü, ÿê³ ìîæóòü áóòè ïåðåäáà÷óâàíèìè òà ÿê³
ìîæëèâî çàïîá³ãòè ïðè ñòàá³ëüíèõ, õðîí³÷íèõ ñòà-
íàõ, ùî ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³,
òà ñòàíàõ ç ïðîãðåñóþ÷èì ïîã³ðøàííÿì. Òîìó,
êîëè ë³êàð³ ÔÐÌ çâåðòàþòüñÿ äî ïîçäîâæí³õ ïî-
òðåá äîïîìîãè ó ñôåð³ îõîðîíè çäîðîâ’ÿ õâîðèõ ç
õðîí³÷íèìè îáìåæåííÿìè æèòòºä³ÿëüíîñò³, âîíè
ïîâèíí³ ðîçãëÿäàòè ìåíåäæìåíò îõîðîíè çäîðîâ’ÿ,
ïîâ’ÿçàíèé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà
çàãàëüí³ ñòðàòå㳿 çì³öíåííÿ çäîðîâ’ÿ, ÿê îäíàêî-
âî âàæëèâ³ êîìïîíåíòè äîïîìîãè. Äëÿ öüîãî âîíè
ïîâèíí³ ïîñèëèòè ñâîþ ñèñòåìó êîìïåòåíòíîñòåé
òà âðàõîâóâàòè êîíöåïö³¿ çì³öíåííÿ çäîðîâ’ÿ òà
çìåíøåííÿ ðèçèêó âòîðèííèõ ñòàí³â58.
Ìåäè÷íà ðåàá³ë³òàö³ÿ ìຠäåê³ëüêà îñîáëèâîñ-
òåé, ÿê³ ñï³âïàäàþòü ÿê ç ïåðâèííîþ ìåäè÷íîþ
äîïîìîãîþ, òàê ³ ç³ çì³öíåííÿì çäîðîâ’ÿ: óñ³ âîíè
ï³äêðåñëþþòü îñâ³òó òà çàîõî÷åííÿ äî ñàìîóïðàâ-
ë³ííÿ òà â³äïîâ³äàëüíîñò³, ðîçãëÿäàþòü ïîòåíö³é-
íèé àáî ôàêòè÷íèé âïëèâ ïåâíîãî ô³çè÷íîãî àáî
êîãí³òèâíîãî/åìîö³éíîãî ñòàíó íà ð³çí³ àñïåêòè
çäîðîâ’ÿ. Íàðåøò³, âñ³ âîíè ðîçãëÿäàþòü ÿê
ï³äòðèìêó çäîðîâ’ÿ, òàê ³ ïîïåðåäæåííÿ õâîðîá, ç
òèì, ùîá ïîêðàùèòè òà çàõèñòèòè ôóíêö³îíàëüí³
çäàòíîñò³ ïðîòÿãîì óñüîãî æèòòÿ58.
ßê ë³êàð³, ùî çàéìàþòüñÿ ôóíêö³ºþ, ë³êàð³ ÔÐÌ
ðîçóì³þòü íåáåçïåêó çíèæåííÿ àêòèâíîñò³ â óñ³õ
çàêëàäàõ âíàñë³äîê óñ³õ ïðè÷èí; ÿê ìåäè÷íèõ, òàê
³ ñåðåäîâèùíèõ. Ôàêòè÷íî, ÷àñòî ë³êàð³ ÔÐÌ º
ºäèíèìè ë³êàðÿìè, ÿê³ îá³çíàí³ ç ï³äòðèìêè ôóíêö³¿
¹2(2) *2018
 ÐÎÇÄ²Ë 8 – ÑÏÅÖ²ÀËÜͲÑÒÜ ÔÐÌ Â ÑÈÑÒÅ̲ ÎÕÎÐÎÍÈ ÇÄÎÐÎÂ’ß ÒÀ ÑÓÑϲËÜÑÒ²
÷åðåç ô³çè÷íó àêòèâí³ñòü ó ñï³âïðàö³ ç ô³çè÷íèìè
òåðàïåâòàìè, íàóêîâöÿìè â ñôåð³ ðóõó, åðãîòåðà-
ïåâòàìè, ìåäè÷íèìè ñåñòðàìè, äîãëÿäà÷àìè òà
÷ëåíàìè ñ³ì’¿. Çíàííÿ ïðî òå, ÿê çì³íèòè ô³çè÷íå òà
ñîö³àëüíå ñåðåäîâèùå äëÿ ìàêñèì³çàö³¿ ôóíêö³î-
íàëüíèõ ðóõ³â òà çàãàëüíîãî ôóíêö³îíóâàííÿ ó ñâî¿õ
ïàö³ºíò³â, äîçâîëÿº ë³êàðÿì ÔÐÌ ïîêðàùóâàòè òà
ï³äòðèìóâàòè ôóíêö³þ äëÿ ñâî¿õ ïàö³ºíò³â. Çîñå-
ðåäæåííÿ íà àêòèâíîñòÿõ ïîâñÿêäåííîãî æèòòÿ
(ÀÏÆ) – öå ñïðîáà ïîâåðíóòè ôóíêö³îíàëüí³ ðóõè
îñîá³ ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³, äîçâîëÿþ÷è
¿ì ï³äòðèìóâàòè áàçîâèé ñòóï³íü ô³çè÷íî¿ àêòèâ-
íîñò³, íåîáõ³äíî¿ äëÿ àâòîíî쳿 òà íåçàëåæíîãî
ðóõó46. Çàõîäè ç ï³äòðèìêè âêëþ÷àþòü ïðîãðàìè,
ñòâîðåí³ ë³êàðåì ÔÐÌ, ùî ñêëàäàþòüñÿ ç çàõîä³â
òà/àáî ìåõàí³çì³â, ÿê³ äîïîìîæóòü áåíåô³ö³àðó ìàê-
ñèì³çóâàòè àáî ï³äòðèìóâàòè ïðîãðåñ, äîñÿãíóòèé
íèì ÷è íåþ ï³ä ÷àñ òåðàﳿ, àáî çàïîá³ãòè, àáî ñïî-
â³ëüíèòè ïîäàëüøå ïîã³ðøåííÿ âíàñë³äîê çàõâîðþ-
âàííÿ ÷è õâîðîáè ó äîâãîòðèâàë³é ïåðñïåêòèâ³.
ϳäòðèìêà, à òàêîæ ïðîô³ëàêòèêà çàõâîðþâàíü
òà çì³öíåííÿ çäîðîâ’ÿ ïîâèíí³ áóòè ³íäèâ³äóàëüíî
àäàïòîâàí³ äî ñòàíó çäîðîâ’ÿ îñîáè, ôóíêö³îíàëü-
íîãî ð³âíÿ òà ïåðñîíàëüíèõ æèòòºâèõ ïëàí³â.
ª îáøèðí³ äîêàçè òîãî, ùî ô³çè÷íà àêòèâí³ñòü
çíèæóº ðèçèê íå³íôåêö³éíèõ çàõâîðþâàíü òà ñïðèÿº
çäîðîâ’þ 59.
Òåðì³í “àäàïòèâíà ô³çè÷íà àêòèâí³ñòü” â³äíî-
ñèòüñÿ äî ô³çè÷íî¿ àêòèâíîñò³, àäàïòîâàíî¿ äî êîí-
êðåòíèõ ïîòðåá êîæíî¿ îñîáè ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³60. Ðåàá³ë³òàö³ÿ, çàñíîâàíà íà àäàï-
òèâí³é ô³çè÷í³é àêòèâíîñò³, ´ðóíòóºòüñÿ íà àäàïòàö³¿
ð³çíèõ âèä³â àêòèâíîñò³, ùîá â³äïîâ³äàòè ïîòðåáàì
êîæíîãî ³íäèâ³äóóìó â ðåàá³ë³òàö³éíîìó çàêëàä³.
Ô³çè÷íå îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà äèñôóí-
êö³ÿ âíàñë³äîê â³äñóòíîñò³ ô³çè÷íî¿ àêòèâíîñò³ òà
äåêîíäèö³îíóâàííÿ ïðèçâîäÿòü äî äîäàòêîâîãî/
ïîñò³éíîãî ô³çè÷íîãî îáìåæåííÿ æèòòºä³ÿëüíîñò³
òà äèñôóíêö³¿61. Çì³öíåííÿ çäîðîâ’ÿ òà â³äïîâ³äí³
îñâ³òí³ çóñèëëÿ äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³-
ÿëüíîñò³, òàêèì ÷èíîì, áóäóòü íåïîâíèìè áåç íà-
äàííÿ êîìïîíåíòó ô³çè÷íî¿ ï³äãîòîâêè58. Òàê³ çà-
õîäè òàêîæ âêëþ÷àòèìóòü ïèòàííÿ ó÷àñò³, òàê³ ÿê
ïîâåðíåííÿ äî ðîáîòè òà ï³äòðèìêó ïåðåáóâàííÿ
íà ðîáîò³, àáî óíèêíåííÿ ðàííüîãî âèõîäó íà ïåí-
ñ³þ âíàñë³äîê ïðîáëåì ç³ çäîðîâ’ÿì. Âèêîðèñòî-
âóâàí³ ìåòîäè âêëþ÷àþòü òåðàïåâòè÷í³ âïðàâè,
àäàïòèâíó ô³çè÷íó àêòèâí³ñòü ³ ñïîðò, çì³íè ñïî-
ñîáó æèòòÿ, âêëþ÷íî ç 䳺òè÷íèìè òà ïñèõîëîã³÷-
íèìè âòðó÷àííÿìè òà îñâ³òó ç ïèòàíü çäîðîâ’ÿ.
Îñîáè ç õðîí³÷íèìè îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³, ÿê³ áðàëè ó÷àñòü ó ³íòåðâåíö³ÿõ, ùî ´ðóíòî-
âàí³ íà àäàïòèâí³é ô³çè÷í³é àêòèâíîñò³, ïðîäåìîí-
ñòðóâàëè ñòàòèñòè÷íî çíà÷óù³ ï³äâèùåííÿ ÿê
ô³çè÷íîãî, òàê ³ ïñèõ³÷íîãî ôóíêö³îíóâàííÿ ïðîòÿ-
ãîì 12 ì³ñÿö³â ï³ñëÿ âòðó÷àííÿ62.
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ðåãóëÿðí³ âïðàâè, ô³çè÷íà àêòèâí³ñòü òà
ï³äòðèìêà âèñîêîãî ð³âíÿ êàðä³îðåñï³ðàòîðíî¿ âè-
òðèâàëîñò³ ââàæàþòüñÿ íåîáõ³äíèìè åëåìåíòàìè
ïðîô³ëàêòèêè òà ë³êóâàííÿ ñåðöåâî-ñóäèííèõ çàõ-
âîðþâàíü òà â³ä³ãðàþòü âàæëèâó ðîëü ó çíèæåíí³
ðèçèêó ³øåì³÷íî¿ õâîðîáè ñåðöÿ ïðè ïåðâèíí³é òà
âòîðèíí³é ïðîô³ëàêòèö³63.
Ó âñüîìó ñâ³òîâ³ â³äñóòí³ñòü ô³çè÷íî¿ àêòèâ-
íîñò³ ïðèçâîäèòü äî 6% âàãè õâîðîáè ³øåì³÷íî¿
õâîðîáè ñåðöÿ64. ϳñëÿ ïðîãðàìè ñåðöåâî¿ ðåàá³-
ë³òàö³¿ ñèäÿ÷èé ñïîñ³á æèòòÿ íåãàòèâíî âïëèâຠíà
îñíîâí³ ôàêòîðè ðèçèêó65. Çäàòí³ñòü äî ô³çè÷íîãî
íàâàíòàæåííÿ º íàéñèëüí³øèì ïðåäèêòîðîì ñìåðò-
íîñò³ â ïîð³âíÿíí³ ç ³íøèìè ôàêòîðàìè ðèçèêó66.
ϳäòðèìêà ô³çè÷íèìè âïðàâàìè – îäèí ç ôàêòîð³â,
ùî ïîë³ïøóþòü ÿê³ñòü æèòòÿ òà ð³âåíü ô³çè÷íî¿
àêòèâíîñò³67. Õî÷à åòàï ï³äòðèìêè (ôàçà 2) êàðä³î-
ëåãåíåâî¿ ðåàá³ë³òàö³¿ º íàéâàæëèâ³øîþ ÷àñòèíîþ
ïðîãðàìè, íà íüîãî ÷àñòî çâåðòàþòü ì³í³ìàëüíó
óâàãó. Óñï³õè ïðîãðàìè 2-¿ ôàçè ìîæóòü áóòè âòðà-
÷åí³ çà íåçíà÷íèé ÷àñ, òàêèé, ÿê ê³ëüêà òèæí³â,
ÿêùî ïàö³ºíò ïåðåñòຠçä³éñíþâàòè çàíÿòòÿ. ×å-
ðåç öå íåîáõ³äíî ï³äêðåñëèòè âàæëèâ³ñòü âèêîíàííÿ
âïðàâ, ÿê ÷àñòèíè íîâèõ çâè÷îê ïàö³ºíòà ó ñôåð³
çäîðîâ’ÿ, ³ ïàö³ºíò ïîâèíåí ³íòåãðóâàòè âïðàâè, ÿê
÷àñòèíó çäîðîâîãî ñïîñîáó æèòòÿ48.
Ó áàãàòüîõ ºâðîïåéñüêèõ öåíòðàõ ïðîïîíóºòü-
ñÿ çíà÷íî òðèâàë³øèé êóðñ ïî÷àòêîâî¿ ëåãåíåâî¿
ðåàá³ë³òàö³¿ (íàïð. ø³ñòü ì³ñÿö³â), àëå â³äñóòí³
äîêàçè òîãî, ùî öå ïðèíîñèòü á³ëüøó êîðèñòü ³
çáåð³ãຠâèêîíàííÿ68. Ó ëåãåíåâ³é ðåàá³ë³òàö³¿ (ËÐ)
òàêîæ ðåêîìåíäóºòüñÿ ïðîäîâæåííÿ ô³çè÷íî¿ àê-
òèâíîñò³ çà ìåæàìè êîíòðîëüîâàíîãî êîìïîíåíòó
ËÐ, îñê³ëüêè ³ñíóþòü äîêàçè òîãî, ùî ïðîãðàìè
ï³äòðèìêè º âèã³äíèìè â çáåðåæåíí³ óñï³õ³â ëåãå-
íåâî¿ ðåàá³ë³òàö³¿69.
Áàð’ºðè ùîäî ó÷àñò³ â ïðîãðàìàõ ï³äòðèìêè ç
ô³çè÷íèìè âïðàâàìè, ÿê³ íåîáõ³äíî äîëàòè – öå
ñòðàõ, â³äñóòí³ñòü ìîòèâàö³¿, ô³íàíñîâ³ òà òðàíñ-
ïîðòí³ àñïåêòè, ôàêòîðè ñåðåäîâèùà, òàê³ ÿê ñî-
ö³àëüíà ³çîëÿö³ÿ òà çì³íè ô³çè÷íîãî çäîðîâ’ÿ.
Ôàõ³âö³ ðåàá³ë³òàö³¿ òà ñîö³àëüíî¿ ï³äòðèìêè ìî-
æóòü çðîáèòè ðåàá³ë³òàö³þ á³ëüø äîâãîòðèâàëîþ
òà ñïðèÿòè ëþäÿì ç õðîí³÷íèìè îáñòðóêòèâíèìè
çàõâîðþâàííÿìè ëåãåíü, áðàòè ó÷àñòü ó àêòèâ-
íîñò³ øëÿõîì ¿õ ìîòèâàö³¿ òà çàîõî÷åííÿ, çìåíøó-
þ÷è ¿õ ñòðàõè òà ïîñèëþþ÷è ïåðåâàãè ó÷àñò³ â àê-
òèâíîñò³ 70 . Ö³ âïðàâè, ô³òíåñ òà ñïîðòèâíà
àêòèâí³ñòü ð³äêî â³äøêîäîâóþòüñÿ, ùî çá³ëüøóº
ïîð³ã äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ àáî
õðîí³÷íèìè çàõâîðþâàííÿìè, ÿê³ ÷àñòî ìàþòü
îáìåæåíèé ïðèáóòîê.
Çàðàç ïð³îðèòåòîì º åôåêòèâíà ï³äòðèìêà ëþ-
äåé, ùî ïåðåæèëè ³íñóëüò, ç ìåòîþ ¿õ ó÷àñò³ ó
ô³çè÷í³é àêòèâíîñò³ ï³ñëÿ ³íñóëüòó. Ó÷àñòü ó âïðà-
âàõ ñåðåäíüî¿ òà âèñîêî¿ ³íòåíñèâíîñò³ çíèæóº
157
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ðèçèê âèíèêíåííÿ ïîâòîðíîãî ³øåì³÷íîãî àáî ãå-
ìîðàã³÷íîãî ³íñóëüòó 71,72, ïîêðàùóº øâèäê³ñòü
ðóõó, ôóíêö³îíàëüíó ìîá³ëüí³ñòü73-75, ì’ÿçîâó ñèëó
òà ù³ëüí³ñòü ê³ñòêîâî¿ òêàíèíè76 ³ ïîçèòèâíî âïëè-
âຠíà ÿê³ñòü æèòòÿ77,78. Êàðä³îðåñï³ðàòîðíå òðå-
íóâàííÿ òà, ìåíøîþ ì³ðîþ, çì³øàíå òðåíóâàííÿ
çíèæóþòü îáìåæåííÿ æèòòºä³ÿëüíîñò³ ï³ä ÷àñ àáî
ï³ñëÿ òðàäèö³éíî¿ äîïîìîãè ïðè ³íñóëüò³; öå ìîæå
áóòè îïîñåðåäêîâàíå ïîë³ïøåííÿì ìîá³ëüíîñò³ òà
ð³âíîâàãè. ª äîñòàòí³é îáñÿã äîêàç³â äëÿ ³íòåãðàö³¿
êàðä³îðåñï³ðàòîðíîãî òà çì³øàíîãî òðåíóâàííÿ,
âêëþ÷íî ç õîäüáîþ, äî ïðîãðàì ï³ñëÿ³íñóëüòíî¿
ðåàá³ë³òàö³¿ äëÿ ï³äâèùåííÿ øâèäêîñò³ òà òîëåðàí-
òíîñò³ äî õîäüáè; òàêîæ ìîæå â³äáóâàòèñÿ ïåâíå
ïîë³ïøåííÿ ð³âíîâàãè79. Ïðîòå ³íñóëüò ïðèçâîäèòü
äî ñêëàäíèõ îáìåæåíü æèòòºä³ÿëüíîñò³, ùî óñêëàä-
íþº ó÷àñòü ó ô³çè÷í³é àêòèâíîñò³, ïîñèëþº ñåðöå-
âî-ñóäèííå äåêîíäèö³îíóâàííÿ80, ùî, ó ñâîþ ÷åð-
ãó, íåãàòèâíî âïëèâຠíà áëàãîïîëó÷÷ÿ, îáìåæåííÿ
æèòòºä³ÿëüíîñò³ òà ôóíêö³îíàëüíó íåçàëåæí³ñòü81
òà ï³äâèùóº ðèçèê ïîâòîðíîãî ³íñóëüòó82. Òîìó ðî-
çóì³ííÿ íàéêðàùî¿ ï³äòðèìêè ó÷àñò³ òèõ, õòî ïåðå-
æèëè ³íñóëüò, ó ðåãóëÿðí³é ô³çè÷í³é àêòèâíîñò³ º
æèòòºâî âàæëèâèì äëÿ ¿õíüîãî çäîðîâ’ÿ òà áëàãî-
ïîëó÷÷ÿ.
Äëÿ ïîêðàùåííÿ ô³çè÷íî¿ ï³äãîòîâêè ó ëþäåé ç
ñïèííîìîçêîâèìè òðàâìàìè ðåêîìåíäóþòüñÿ íà-
ñòóïí³ äîêàçîâ³ íàñòàíîâè ùîäî ô³çè÷íî¿ àêòèâ-
íîñò³: äëÿ âàæëèâèõ óñï³õ³â ó ô³òíåñ³ äîðîñë³ ç
ÑÌÒ ïîâèíí³ çàéìàòèñÿ (à) ïðèíàéìí³ 20 õâèëèí
äâ³÷³ íà òèæäåíü àåðîáíîþ àêòèâí³ñòþ ñåðåäíüî¿
àáî ñèëüíî¿ ³íòåíñèâíîñò³ ³ (á) òðåíóâàííÿì ñèëè
äâ³÷³ íà òèæäåíü, ùî ñêëàäàºòüñÿ ç òðüîõ íàáîð³â
ïî 8-10 ïîâòîðåíü êîæíî¿ âïðàâè äëÿ êîæíî¿ âåëè-
êî¿ ãðóïè ì’ÿç³â83.
Ó äåÿêèõ ºâðîïåéñüêèõ êðà¿íàõ (íàïð. ó Àâñòð³¿,
ͳìå÷÷èí³, ²òà볿, Ïîëüù³) ðåàá³ë³òàö³ÿ â ñòàö³îíàð³
àáî äåííèõ ñòàö³îíàðàõ â³ä³ãðຠâàæëèâó ðîëü ó ìå-
íåäæìåíò³ á³ëüøîñò³ õðîí³÷íèõ ñòàí³â, íàïð. õðîí³-
÷íèõ ì’ÿçîâî-ñêåëåòíèõ òà íåðâîâî-ì’ÿçîâèõ ðîçëà-
äàõ, õðîí³÷íèõ ñóäèííèõ, äèõàëüíèõ òà ìåòàáîë³÷íèõ
çàõâîðþâàííÿõ, à òàêîæ çàõâîðþâàííÿõ øê³ðè, óðî-
ëîã³÷íèõ òà ã³íåêîëîã³÷íèõ ñòàíàõ. Ïåð³îäè÷í³ ñïëåñ-
êè ³íòåíñèâíî¿ ðåàá³ë³òàö³¿ òàêîæ ìîæóòü áóòè âèêî-
ðèñòàí³ äëÿ áîðîòüáè ç³ çíèæåííÿì ôóíêö³¿ íàâ³òü
÷åðåç ê³ëüêà ðîê³â ï³ñëÿ ãîñòðî¿ ïî䳿84.
Ãëîáàëüíå çì³öíåííÿ çäîðîâ’ÿ â ô³çè÷í³é
òà ðåàá³ë³òàö³éí³é ìåäèöèí³
Âíåñîê ë³êàð³â ÔÐÌ ó «ãëîáàëüíå çì³öíåííÿ
çäîðîâ’ÿ» ïîâèíåí áóòè îïèñàíèé ç ïîñèëàíí³ íà
êîíöåïòóàëüíó ïåðñïåêòèâó òà ö³ë³ «Ãëîáàëüíîãî
Ïëàíó ä³é ç îáìåæåíü æèòòºä³ÿëüíîñò³ 2014-
2021»4. ˳êàð³ ÔÐÌ ìîæóòü â³ä³ãðàâàòè ïåâíó ðîëü
ó çàáåçïå÷åíí³ äîñÿãíåííÿ òðüîõ ãîëîâíèõ ö³ëåé
158 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ïëàíó ä³é, à ñàìå: óñóíåííÿ áàð’ºð³â äëÿ ïîñëóã òà
ïðîãðàì ç îõîðîíè çäîðîâ’ÿ; çì³öíåííÿ òà ðîçøè-
ðåííÿ ðåàá³ë³òàö³¿, àá³ë³òàö³¿ òà ³íøèõ ï³äòðèìóþ-
÷èõ òåõíîëîã³é òà ïîñëóã; ïîñèëåííÿ çáîðó äàíèõ
òà ï³äòðèìóâàííÿ äîñë³äæåíü îáìåæåíü æèòòºä³-
ÿëüíîñò³ òà ïîâ’ÿçàíèõ ïîñëóã85.
Ïëàí âèçíຠÎáìåæåííÿ æèòòºä³ÿëüíîñò³, ÿê
«ãëîáàëüíå ïèòàííÿ îõîðîíè çäîðîâ’ÿ», à Ðåàá³ë³-
òàö³þ – ÿê åôåêòèâíèé çàõ³ä çìåíøåííÿ ñîö³àëü-
íîãî âïëèâó øèðîêîãî êîëà ñòàí³â, ùî ïðèçâîäÿòü
äî îáìåæåíü æèòòºä³ÿëüíîñò³, òèì ñàìèì ðîáëÿ-
÷è âèñíîâîê, ùî ðåàá³ë³òàö³ÿ ïîâèííà áóòè âêëþ-
÷åíà â êîíöåïö³þ óí³âåðñàëüíîãî ïîêðèòòÿ îõîðî-
íîþ çäîðîâ’ÿ.
Ñîö³àëüí³ òà êë³í³êî-åï³äåì³îëîã³÷í³ òåíäåíö³¿,
òàê³, ÿê ñòàð³ííÿ íàñåëåííÿ, çá³ëüøåííÿ ïîøèðå-
íîñò³ õðîí³÷íèõ ñòàí³â, ùî ïðèçâîäÿòü äî ôóíêö³î-
íàëüíèõ îáìåæåíü, ï³äâèùåííÿ ð³âíÿ âèæèâàííÿ
ïðè áàãàòüîõ ð³çíèõ ñòàíàõ, à òàêîæ ï³äâèùåííÿ
îá³çíàíîñò³ ãðîìàäñüêîñò³ ùîäî ö³ííîñò³ ñîö³àëü-
íî¿ ó÷àñò³, âèìàãàþòü çá³ëüøåííÿ ðîë³ ðåàá³ë³òàö³¿
â îõîðîí³ çäîðîâ’ÿ.  ðàìêàõ çàãàëüíî¿ ðåàá³ë³òàö³¿,
ÔÐÌ º ìåäè÷íîþ ñïåö³àëüí³ñòþ, ÿêà, â³äíîñíî äî
áàãàòüîõ ³íøèõ êë³í³÷íèõ äèñöèïë³í, ìîæå çðîáè-
òè âàæëèâèé âíåñîê ó çàãàëüíå çì³öíåííÿ çäîðî-
â’ÿ ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ àáî
ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâîäÿòü äî îáìåæåíü
æèòòºä³ÿëüíîñò³, òà õðîí³÷íèìè çàõâîðþâàííÿìè.
˳êàð³ ÔÐÌ ïðàöþþòü íà êë³í³÷íîìó ð³âí³ (ç
ìåòîþ ï³äâèùåííÿ çäàòíîñò³ îñ³á âçàºìîä³ÿòè ç
ñåðåäîâèùåì) òà íà ð³âí³ ñåðåäîâèùà (ç ìåòîþ
çàáåçïå÷åííÿ îïòèìàëüíîãî ñåðåäîâèùà äëÿ ðåà-
ë³çàö³¿ òàêèõ çäàòíîñòåé).
Ïîçèòèâíèé âïëèâ ñïåö³àëüíîñò³ ÔÐÌ íà ãëî-
áàëüíå çì³öíåííÿ çäîðîâ’ÿ ìîæëèâî âèçíà÷èòè
ñòîñîâíî:
– çá³ëüøåííÿ çàãàëüíîãî ð³âíÿ çäîðîâ’ÿ, ôóíêö³-
îíóâàííÿ, áëàãîïîëó÷÷ÿ òà ñîö³àëüíî¿ ó÷àñò³
îñ³á ç õðîí³÷íèìè çàõâîðþâàííÿìè, àáî îáìå-
æåííÿìè æèòòºä³ÿëüíîñò³, àáî ñòàíàìè çäîðî-
â’ÿ, ùî ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëü-
íîñò³, íà ïîïóëÿö³éíîìó ð³âí³ (íàïð. íà ð³âí³
ðåã³îíó, êðà¿íè àáî ó âñüîìó ñâ³òîâ³);
– çìåíøåííÿ òÿãàðÿ õâîðîá òà îáìåæåíü æèòòº-
ä³ÿëüíîñò³ íà ñîö³àëüíîìó ð³âí³, òîáòî ïîì’ÿê-
øåííÿ âïëèâó ñòàí³â, ùî ïðèçâîäÿòü äî îáìå-
æåíü æèòòºä³ÿëüíîñò³ íà ðîäèíè, ñèñòåìè
îõîðîíè çäîðîâ’ÿ òà ñîö³àëüí³ ïîñëóãè;
– âíåñêó ó âèçíàííÿ ö³ííîñò³ òà ã³äíîñò³ â³äì³ííî-
ñòåé ì³æ ëþäñüêèìè ³ñòîòàìè, òèì ñàìèì ïðî-
ïàãóþ÷è ðîçâèòîê ñòàâëåííÿ äî ñîö³àëüíî¿
³íêëþ糿 ó ãðîìàä³.
̳æíàðîäíà êëàñèô³êàö³ÿ ôóíêö³îíóâàííÿ, îá-
ìåæåíü æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ) 86 º
øèðîêî ðîçïîâñþäæåíîþ òà âèçíàíîþ äîâ³äêîâîþ
¹2(2) *2018
 ÐÎÇÄ²Ë 8 – ÑÏÅÖ²ÀËÜͲÑÒÜ ÔÐÌ Â ÑÈÑÒÅ̲ ÎÕÎÐÎÍÈ ÇÄÎÐÎÂ’ß ÒÀ ÑÓÑϲËÜÑÒ²
êîíöåïòóàëüíîþ ìîäåëëþ ô³çè÷íî¿ òà ðåàá³ë³òàö-
³éíî¿ ìåäèöèíè ³ ìîæå ñëóãóâàòè ðåôåðåíòíîþ
ìîäåëëþ ãëîáàëüíîãî çì³öíåííÿ çäîðîâ’ÿ. ³äïî-
â³äíèì àñïåêòîì ìîäåë³ ÌÊÔ º àêöåíò íà «êîì-
ïîíåíò³ çäîðîâ’ÿ», à íå íà «íàñë³äêó çàõâîðþâàíü»,
òèì ñàìèì ï³äêðåñëþþ÷è êîíöåïö³þ êîíòèíóóìó
ñòàí³â çäîðîâ’ÿ, ïðîòèëåæíî äî äóàë³çìó ì³æ çäî-
ðîâ’ÿì òà õâîðîáàìè. ²íøèé àñïåêò ïîëÿãຠâ òîìó,
ùî ÌÊÔ ÿâíî ñïðÿìîâàíà íà îïåðàö³îíàë³çàö³¿ á³î-
ïñèõî-ñîö³àëüíî¿ ìîäåë³, ÿêà øèðîêî ïðèéíÿòà â
ÔÐÌ.
Ñòðàòå㳿, çà äîïîìîãîþ ÿêèõ ñïåö³àëüí³ñòü
ÔÐÌ ìîæå ñïðèÿòè ãëîáàëüíîìó çì³öíåííþ çäî-
ðîâ’ÿ, áàçóþòüñÿ íà:
– âçàºìîâ³äíîñèíàõ ç øèðîêèì êîëîì ôàõ³âö³â
îõîðîíè çäîðîâ’ÿ íå ëèøå â ñôåð³ ðåàá³ë³òàö³¿,
àëå é â ³íøèõ äèñöèïë³íàõ. Ç ö³º¿ òî÷êè çîðó, âçàº-
ìîçâ’ÿçêè ³ç ë³êàðÿìè çàãàëüíî¿ ïðàêòèêè òà
³íøèìè ôàõ³âöÿìè ïåðâèííî¿ ìåäè÷íî¿ äîïîìî-
ãè, çäàºòüñÿ, â³ä³ãðàþòü âèð³øàëüíó ðîëü;
– âçàºìîâ³äíîñèíàõ òà ñï³âïðàö³ ç íèçêîþ ôàõ³âö³â
òà ïîñëóã ó ñôåðàõ ñîö³àëüíîãî çàõèñòó, äîáðî-
áóòó òà ïîñëóã â ãðîìàä³, ïðàö³, îñâ³òè òîùî;
– âçàºìîâ³äíîñèíàõ òà ñï³âïðàö³ ç ãðîìàäàìè,
âîëîíòåðñüêèìè îðãàí³çàö³ÿìè, àñîö³àö³ÿìè îñ³á
ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³, àáî ³íøèìè
ñïîæèâà÷àìè, ðîäèíàìè òîùî;
– ñï³âïðàö³ ç áàãàòüìà ïðîôåñ³éíèìè òà íåïðîôå-
ñ³éíèìè îðãàí³çàö³ÿìè ó çàîõî÷åíí³ ì³æäèñöèï-
ë³íàðíîãî òà ì³æïðîôåñ³éíîãî ï³äõîäó äî íàäàí-
íÿ ðåàá³ë³òàö³éíèõ ïîñëóã.
ijÿìè, çà äîïîìîãîþ ÿêèõ ÔÐÌ ìîæóòü ðîáè-
òè âíåñîê äî ãëîáàëüíîãî çì³öíåííÿ çäîðîâ’ÿ, º:
– ñïðèÿííÿ äîñòóïó îñ³á ç îáìåæåííÿìè æèòòº-
ä³ÿëüíîñò³ àáî ç³ ñòàíàìè çäîðîâ’ÿ, ÿê³ ìîæóòü
ïðèçâåñòè äî îáìåæåíü æèòòºä³ÿëüíîñò³, äî ïî-
ñëóã ³ ïðîãðàì â ñôåð³ îõîðîí³ çäîðîâ’ÿ;
– ïðîñâ³òà ôàõ³âö³â ñôåðè îõîðîíè çäîðîâ’ÿ ùîäî
îáìåæåíü æèòòºä³ÿëüíîñò³ òà âïëèâó ñòàí³â çäî-
ðîâ’ÿ, ÿê³ ìîæóòü ïðèçâåñòè äî îáìåæåíü æèò-
òºä³ÿëüíîñò³, íà ìåäè÷í³ àñïåêòè òà íàâïàêè;
– ï³äâèùåííÿ ð³âíÿ îá³çíàíîñò³ çàêëàä³â, ôàõ³âö³â
òà ãðîìàäñüêîñò³ â øèðîêîìó ñåíñ³ ç òåìàòè-
êè îáìåæåíü æèòòºä³ÿëüíîñò³ òà ó÷àñò³;
– ïðîïàãóâàííÿ çäîðîâîãî ñïîñîáó æèòòÿ îñ³á ç
îáìåæåííÿìè æèòòºä³ÿëüíîñò³. Çîêðåìà, ÔÐÌ
çàëó÷åíà äî çàõîä³â ñïðèÿííÿ çàîõî÷åííÿ äî ðå-
ãóëÿðíî¿ ô³çè÷íî¿ àêòèâíîñò³;
– ïðîñóâàííÿ âèçíàííÿ “ôóíêö³îíóâàííÿ”, ÿê â³ä-
ïîâ³äíî¿ êë³í³÷íî¿ ðèñè, â äåÿêèõ ñôåðàõ îõîðî-
íè çäîðîâ’ÿ, âêëþ÷àþ÷è ïåðâèííó ìåäè÷íó äî-
ïîìîãó òà çàêëàäè ãîñòðî¿ ìåäè÷íî¿ äîïîìîãè;
– ïðîìîòóâàííÿ øèðîêîãî âêëþ÷åííÿ ôóíêö³î-
íàëüíîãî îö³íþâàííÿ â ñèñòåìàõ îõîðîíè çäî-
ðîâ’ÿ òà ïðèéíÿòòÿ ñï³ëüíî¿ ìîâè äëÿ îïèñó ôóíê-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ö³îíóâàííÿ (íàïð. øëÿõîì ñïðèÿííÿ ðîçðîáö³
ïðîñòèõ, ³íòó¿òèâíî çðîçóì³ëèõ ³íñòðóìåíò³â
îö³íþâàííÿ íà îñíîâ³ òàêñîíî쳿 ÌÊÔ87-89;
– ñï³âïðàöÿ ç ôàõ³âöÿìè ïåðâèííî¿ äîïîìîãè (ë³êà-
ðÿìè çàãàëüíî¿ ïðàêòèêè òà ³íøèìè ôàõ³âöÿìè)
çàäëÿ ðîçøèðåííÿ ïåðâèííèõ ðåàá³ë³òàö³éíèõ
ïîñëóã òà ôîðìóâàííÿ çâ’ÿçê³â ïåðâèííèõ ïî-
ñëóã ³ç âòîðèííèìè òà òðåòèííèìè ðåàá³ë³òà-
ö³éíèìè öåíòðàìè òà çàêëàäàìè, ñïðèÿþ÷è, òà-
êèì ÷èíîì, ðîçâèòêó ³íòåãðîâàíèõ ìåðåæ
ðåàá³ë³òàö³éíèõ ïîñëóã íà ì³ñöåâîìó, ðåã³îíàëü-
íîìó òà íàö³îíàëüíîìó ð³âíÿõ;
– ñï³âïðàöÿ ó ïðîñóâàíí³ ðåàá³ë³òàö³¿, ùî íàäàºòü-
ñÿ â ãðîìàä³ òà ïîºäíàíí³ ö³º¿ ñôåðè âòðó÷àííÿ
ç á³ëüø ñïåö³àë³çîâàíèìè ð³âíÿìè ðåàá³ë³òàö³¿;
– ï³äâèùåííÿ îá³çíàíîñò³ òà ïîêðàùåííÿ äîñòó-
ïó òà ñòàâëåííÿ çàêëàä³â òà ôàõ³âö³â îõîðîíè
çäîðîâ’ÿ äî ïðîô³ëàêòè÷íèõ ñêðèí³íã³â çäîðîâ’ÿ
(íàïð. ñòîìàòîëîã³÷íà äîïîìîãà) äëÿ îñ³á ç îá-
ìåæåííÿìè æèòòºä³ÿëüíîñò³, çîêðåìà æ³íîê
ùîäî ã³íåêîëîã³÷íèõ ñêðèí³íã³â90;
– âíåñîê ó çáèðàííÿ äàíèõ òà äîñë³äæåííÿ îáìå-
æåíü æèòòºä³ÿëüíîñò³ íà ïîïóëÿö³éíîìó ð³âí³
(íàïð. åï³äåì³îëî㳿 ôóíêö³îíàëüíèõ îáìåæåíü)
òà ðîçðîáö³ é âïðîâàäæåíí³ ³ííîâàö³éíèõ ìîäå-
ëåé äëÿ çàäîâîëåííÿ âèíèêàþ÷èõ ïîòðåá îñ³á ç
îáìåæåííÿìè æèòòºä³ÿëüíîñò³.
Åòèêà òà ïîñëóãè ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
ÂÎÎÇ çàïðîïîíóâàëà ðåàá³ë³òàö³þ, ÿê êëþ÷îâó
ñòðàòåã³þ çäîðîâ’ÿ ÕÕ² ñòîë³òòÿ91. Á³ëüøå òîãî,
ïîòðåáè â ðåàá³ë³òàö³¿ çðîñòàþòü âíàñë³äîê ñó÷àñ-
íèõ òåíäåíö³é îõîðîíè çäîðîâ’ÿ, òàêèõ, ÿê ñòàð³ííÿ
íàñåëåííÿ, ïîêðàùåííÿ çíàíü òà íîâ³ ìåäè÷í³ òåõ-
íîëî㳿, çá³ëüøåííÿ ïîêàçíèê³â âèæèâàííÿ òà î÷³êó-
âàíî¿ òðèâàëîñò³ æèòòÿ, ïîøèðåííÿ õðîí³÷íèõ ñòàí³â,
ðàíí³é ïî÷àòîê ðåàá³ë³òàö³¿ òà ðàííÿ âèïèñêà ç ãîñ-
òðî¿ äîïîìîãè. Îòæå, âèòðàòè íà ðåàá³ë³òàö³þ çðî-
ñòàþòü ó ïîð³âíÿíí³ ç³ ñêîðî÷åííÿì áþäæåò³â. Öå
ïåðåäáà÷ຠâèá³ð íà ìàêðî-, ìåçî- òà ì³êðîð³âí³
îõîðîíè çäîðîâ’ÿ92. Á³îåòè÷í³ ïðîáëåìè (åòè÷í³
ïðîáëåìè â êîíòåêñò³ îõîðîíè çäîðîâ’ÿ) ïîâ’ÿçàí³
ç òðüîìà îñíîâíèìè ìîðàëüíèìè ïðèíöèïàìè: ïîâà-
ãà äî àâòîíî쳿, äîáðî÷åñí³ñòü ïðîòè íåøê³äëèâîñò³
òà ñïðàâåäëèâ³ñòü20. Ïîâàãà äî öèõ ïðèíöèï³â ìîæå
ïðèçâåñòè äî êîíôë³êòíèõ ñèòóàö³é òà åòè÷íèõ äèëåì.
Åòè÷í³ ïðîáëåìè, ùî çàíóðåí³ íà ìàêðî- (ïî-
ë³òèêà îõîðîíè çäîðîâ’ÿ) òà ì³êðîð³âí³ (ð³âåíü âçàº-
ìî䳿 ç ïàö³ºíòîì), îáãîâîðþâàëèñÿ â ïîïåðåäí³õ
ðîçä³ëàõ (â³äïîâ³äíî 2 òà 7). Öåé ðîçä³ë ïðèñâÿ÷å-
íî âèáîðó, ÿêèé íåîáõ³äíî çðîáèòè íà ìåçî-ð³âí³
(îðãàí³çàö³ÿ îõîðîíè çäîðîâ’ÿ: ë³êàðí³, ðåàá³ë³-
òàö³éí³ ñëóæáè òîùî).
159
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Âàæëèâèì çàâäàííÿì äëÿ ë³êàð³â ÔÐÌ º âèá³ð
ïàö³ºíò³â àáî «ñîðòóâàííÿ» äëÿ äîñòóïó äî ðåàá³-
ë³òàö³éíî¿ ïðîãðàìè àáî ïîñëóãè21. Ìåòà ïîëÿãຠâ
òîìó, ùîá íàëåæíèé ïàö³ºíò îòðèìàâ íàëåæíèé
ð³âåíü äîïîìîãè â íàëåæíèé ìîìåíò ÷àñó ç â³äïî-
â³äíèì ô³íàíñóâàííÿì. Ñîðòóâàííÿ ïîâèííî áàçó-
âàòèñÿ íà áàãàòîâèì³ðíîìó ôóíêö³îíàëüíîìó ñòàí³
ïàö³ºíòà òà âêëþ÷àòè ÿê ìåäè÷í³, òàê ³ íå ìåäè÷í³
ôàêòîðè. Îòæå, ïîòð³áíà ñèñòåìà êëàñèô³êàö³¿
ïàö³ºíò³â àáî ñîðòóâàëüíèé ³íñòðóìåíò. Öå òàêîæ
ìຠâðàõîâóâàòè ñêëàäí³ñòü ðåàá³ë³òàö³éíèõ ïî-
òðåá ³ ö³ëåé ïàö³ºíòà, à òàêîæ éîãî âèáîðó. ²íøèì
ïàðàìåòðîì º ÷àñòîòà òà ïîøèðåí³ñòü îñíîâíîãî
ñòàíó çäîðîâ’ÿ, ³ ìåíø ÷àñò³ ñòàíè âèìàãàþòü
á³ëüø ñïåöèô³÷íèõ ïîñëóã, îñîáëèâî ó âèïàäêó
ñêëàäíèõ ö³ëåé. Ñèñòåìà êëàñèô³êàö³¿ / îö³íêè ïà-
ö³ºíòà ïîâèííà âèêîðèñòîâóâàòèñü ç ïî÷àòêó ãîñ-
òðî¿ ôàç³ ç ìåòîþ ñêåðóâàííÿ ïàö³ºíòà äî ïîñëóãè,
ÿêà ïðîïîíóº íàëåæíèé ð³âåíü ðåàá³ë³òàö³éíî¿ äî-
ïîìîãè, âïðîäîâæ âñüîãî êîíòèíóóìó äîïîìîãè
(äèâ. Ìàëþíîê 1). Ïðîòå, á³ëüø³ñòü ðåàá³ë³òàö³é-
íèõ ñëóæá ìàþòü îáìåæåíó ê³ëüê³ñòü ñòàö³îíàð-
íèõ òà àìáóëàòîðíèõ ì³ñöü, à âàæê³ ð³øåííÿ ùîäî
íàäõîäæåííÿ òà âèïèñêè ïàö³ºíò³â ìàþòü ïðèéìà-
òèñÿ ùîäíÿ. Íàéêðàùèé âèá³ð äëÿ ïàö³ºíòà (ïðèí-
öèï äîáðî÷åñíîñò³) ïîâèíåí ìàòè ïåðåâàãó, àëå öåé
âèá³ð ìîæå ñóïåðå÷èòè íàÿâíîìó áþäæåòó òà
á³ëüø óòèë³òàðíèì ì³ðêóâàííÿì. Òàêèé ñàìèé
êîíôë³êò ìîæå âèíèêíóòè ïðè âèïèñö³ ïàö³ºíòà. Ó
á³ëüøîñò³ ºâðîïåéñüêèõ êðà¿í ê³ëüê³ñòü ñïåö³àë³çî-
âàíèõ óñòàíîâ äëÿ äîðîñëèõ ç òÿæêèìè ôîðìàìè
îáìåæåíü æèòòºä³ÿëüíîñò³, ÿê³ íå ìîæóòü ïîâåð-
íóòèñÿ äîäîìó, º íåäîñòàòíüîþ. Öå ñòâîðþº ïðî-
áëåìè ç âèïèñêîþ, à îòæå, ³ íàäõîäæåííÿì («áëî-
êóâàëüíèêè ë³æêà»). Á³ëüøå òîãî, äåÿê³ ïàö³ºíòè
âèïèñóþòüñÿ äî íåíàëåæíèõ çàêëàä³â, òàêèõ, ÿê
íåñïåö³àë³çîâàí³ áóäèíêè äëÿ ë³òí³õ ëþäåé. Ó ìå-
æàõ îáìåæåíèõ (³ íàðàç³ òèõ, ùî ñêîðî÷óþòüñÿ)
áþäæåò³â íàÿâí³ ô³íàíñîâ³ ðåñóðñè ïîâèíí³ áóòè
ðîçïîä³ëåí³ “ñïðàâåäëèâî” (ïðèíöèï ñïðàâåäëè-
âîñò³).
²íøå ïèòàííÿ íà ìåçî-ð³âí³ ñòîñóºòüñÿ ñòàâëåí-
íÿ ôàõ³âö³â îõîðîíè çäîðîâ’ÿ äî îñ³á ç îáìåæåí-
íÿìè æèòòºä³ÿëüíîñò³ òà õðîí³÷íèìè çàõâîðþâàí-
íÿìè. Öå ìîæå âàð³þâàòè çàëåæíî â³ä áà÷åííÿ òà
âñòàíîâëåííÿ ïð³îðèòåò³â â çàêëàäàõ îõîðîíè çäî-
ðîâ’ÿ. Íàïð., äîñòóï äî ã³íåêîëîã³÷íèõ òà àêó-
øåðñüêèõ ïîñëóã äëÿ æ³íîê íà â³çêàõ, à òàêîæ
â³äñóòí³ñòü îá³çíàíîñò³ òà çíàíü â³äïîâ³äíèõ
ôàõ³âö³â îõîðîíè çäîðîâ’ÿ ÷àñòî º ïåðåøêîäîþ äëÿ
ðåãóëÿðíèõ ìåäè÷íèõ îãëÿä³â öèõ æ³íîê ç îñîáëè-
âèìè ïîòðåáàìè.
²íêëþç³ÿ ïàö³ºíòà òà éîãî/¿¿ ðîäèíè, à òàêîæ çà-
ëó÷åííÿ ð³âíèõ êîíñóëüòàíò³â äî ðåàá³ë³òàö³éíî¿
êîìàíäè, áóäå çàëåæàòè â³ä ïàö³ºíò-ñïðÿìîâàíîñò³
160 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
êîíêðåòíî¿ ðåàá³ë³òàö³éíî¿ ñëóæáè àáî çàêëàäó â
ö³ëîìó.
Ïðîòÿãîì îñòàíí³õ äåñÿòèë³òü âèêîðèñòàííÿ
òåõíîëîã³é ó ðåàá³ë³òàö³¿ çíà÷íî çðîñëî. Ðîáîòî-
òåõí³êà ³ á³îí³êà íàëåæàòü äî ùîäåííî¿ ïðàêòèêè.
Îòæå, åòè÷íå ïèòàííÿ òóò á³ëüøå íå «÷è âàðòî
âèêîðèñòîâóâàòè òåõíîëîã³þ», àëå «ÿê âèêîðèñòî-
âóâàòè òåõíîëîã³þ», àáî «ÿê òåõíîëîã³ÿ âïëèâຠíà
íàøå æèòòÿ, à íàøà ïîâåä³íêà, ÿê òåõí³êà, ôîðìóº
íàø³ 䳿 òà äîñâ³ä»93.
Íà çàê³í÷åííÿ, â ðåàá³ë³òàö³éí³é ïðàêòèö³ ìè âñå
á³ëüøå ñòèêàºìîñÿ ç äåë³êàòíèìè åòè÷íèìè ïèòàí-
íÿìè. гøåííÿ ìàþòü ïðèéìàòèñÿ ùîäíÿ íà ì³êðî,
ìåçî-, à òàêîæ íà ìàêðîð³âí³ îõîðîíè çäîðîâ’ÿ.
Åòè÷í³ ö³ííîñò³ òà êóëüòóðàëüí³ ïåðåêîíàííÿ ïðî-
ôåñ³îíàë³â, à òàêîæ ïàö³ºíò³â âïëèâàþòü íà âèá³ð
ó ïðàêòèö³ ðåàá³ë³òàö³¿. Ìè ïîâèíí³ óñâ³äîìëþâà-
òè òîé ôàêò, ùî êóëüòóðàëüí³ â³äì³ííîñò³ ìîæóòü
âïëèíóòè íà ðåçóëüòàò âòðó÷àííÿ. Òîìó åòè÷í³ òà
êóëüòóðàëüí³ ïèòàííÿ ïîâèíí³ áóòè ÷àñòèíîþ íà-
â÷àëüíèõ ïðîãðàì ç ðåàá³ë³òàö³¿ òà ï³ñëÿäèïëîìíî¿
ï³äãîòîâêè, òàêîæ ³ ç ïèòàíü âèêîðèñòàííÿ òåõíî-
ëî㳿. Ôàõ³âöÿì ðåàá³ë³òàö³¿ ïîòð³áåí ÷àñ, ùîá çà-
äóìàòèñÿ íàä öèìè ïðîáëåìàìè ç êîëåãàìè òà
ð³âíèìè êîíñóëüòàíòàìè.
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Iocco M., et al. Toward an International Classification of
Functioning, Disability and Health clinical data collection tool:
the Italian experience of developing simple, intuitive
descriptions of the Rehabilitation Set categories. Eur J Phys
Rehabil Med. 2017 Apr;53(2):290–8.
88. Prodinger B., Scheel-Sailer A., Escorpiso R., Stucki G. UEMS
PRM Workshop report: toward the development of clinical
assessment schedules for specified rehabilitation services. Eur
J Phys Rehabil Med. 2016;
89. Schopp L.H., Sanford T.C., Hagglund K.J., Gay J.W., Coatney
M.A. Removing service barriers for women with physical
disabilities: promoting accessibility in the gynecologic care
setting. J Midwifery Womens Health. 2002 Apr;47(2):74–9.
90. Stucki G. Olle Höök Lectureship 2015: The World Health
Organization’s paradigm shift and implementation of the
International Classification of Functioning, Disability and
Health in rehabilitation. J Rehabil Med. 2016 Jun
13;48(6):486–93.
91. Kiekens C., DE Tavernier J. Ethical choices in rehabilitation.
Eur J Phys Rehabil Med. 2016 Aug;52(4):419–21.
92. Peter Paul Verbeek. Moralizing Technology. Understanding
and designing the morality of things. The University of Chicago
Press Books. 2011.
93. Kiekens C., Van Rie K., Leys M., Cleemput I., Smet M.,
Kesteloot K., et al. Organisation and financing of
musculoskeletal and neurological rehabilitation in Belgium.
KCE study 2005-18 Health Services Research (HSR).
[Internet]. Available from: https://kce.fgov.be/publication/
report/organisation-and-financing-of-musculoskeletal-and-
neurological-rehabilitation

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Carlotte Kiekens,
Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner,
Sasa Moslavac, Enrique Varela-Donoso, Anthony B Ward, Mauro Zampolini, Stefano Negrini.
• Ó÷àñíèêè: Filipe Antunes, Paolo Boldrini, Christoph Gutenbrunner, Alvydas Juocevicius, Carlotte Kiekens,
Francois Constant Boyer, John PS Burn, Pedro Cantista, Mark Delargy, Gordana Deveèerski, Enrique Varela-
Donoso, Calogero Foti, Alessandro Giustini, Jean-Jacques Glaesener, Jacinta McElligott, Angela McNamara,
Anda Nulle, Aydan Oral, Daiana Popa, Christina-Anastasia Rapidi, Amandine Rapin, Katharina Stibrant
Sunnerhagen, Peter Takac, Jiri Votava, Andreas Winkelmann, Jan HB Geertzen, Kurt Hoppe, Ilse J.W. van
Nes, Steven Rimbaut, Rochelle T. Dy, Christof A.J. Smit, Raquel Valero, Anthony B Ward, Alain Yelnik.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 163
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

(ÔÐM) â ªâðîï³.
Ðîçä³ë 9 – Îñâ³òà ³ áåçïåðåðâíèé ïðîôåñ³éíèé ðîçâèòîê:
ôîðìóâàííÿ ìàéáóòíüîãî ÔÐÌ
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
Ó êîíòåêñò³ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ) öåé ðîçä³ë ïðèñâÿ÷åíèé îñâ³ò³ ë³êàð³â ÔÐÌ ó
ªâðîï³. Ùîá çäîáóòè íåîáõ³äíó ñôåðó êîìïåòåíòíîñòåé, ñïåö³àë³ñòè ô³çè÷íî¿ ³ ðåàá³ë³òàö³éíî¿ ìåäèöèíè ïîâèíí³ ïðîé-
òè äîáðå îðãàí³çîâàíå ³ íàëåæíèì ÷èíîì ñòðóêòóðîâàíå íàâ÷àííÿ àäåêâàòíî¿ òðèâàëîñò³. Ôàêòè÷íî, âîíè ïîâèíí³
ðîçâèâàòè íå ò³ëüêè ìåäè÷í³ çíàííÿ, àëå òàêîæ êîìïåòåíòí³ñòü â îáëàñò³ äîïîìîãè ïàö³ºíòàì, ñïåöèô³÷í³ ïðîöåäóðí³
íàâè÷êè ³ ñòàâëåííÿ ùîäî ì³æîñîáèñò³ñíèõ â³äíîñèí ³ êîìóí³êàö³¿, ãëèáîêå ðîçóì³ííÿ îñíîâíèõ ïðèíöèï³â ìåäè÷íî¿
åòèêè òà ãðîìàäñüêîãî çäîðîâ’ÿ, çäàòí³ñòü çàñòîñîâóâàòè ïðàâèëà äîïîìîãè òà ïðîô³ëàêòèêè â³äíîñíî äî îñ³á ç îáìå-
æåííÿìè æèòòºä³ÿëüíîñò³, çäàòí³ñòü îñâîþâàòè ñòðàòå㳿 ðå³íòåãðàö³¿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ äî ñóñï³ëü-
ñòâà, çàñòîñîâóâàòè ïðèíöèïè çàáåçïå÷åííÿ ÿêîñò³ ³ ñïðèÿòè áåçïåðåðâíîìó ïðîôåñ³éíîìó ðîçâèòêó, ùî ´ðóíòóºòüñÿ
íà ïðàêòè÷í³é ä³ÿëüíîñò³. Öåé äîêóìåíò ì³ñòèòü îíîâëåíó äåòàë³çîâàíó ³íôîðìàö³þ ïðî îñâ³òó òà ï³äãîòîâêó ñïå-
ö³àë³ñò³â, íàäຠðåêîìåíäàö³¿ ùîäî ñòàíäàðò³â, ùî âèìàãàþòüñÿ íà ºâðîïåéñüêîìó ð³âí³, çã³äíî äî ïðàâèë ªÑÌÑ ùîäî
ñòâîðåííÿ çàãàëüíî¿ ñòðóêòóðè íàâ÷àííÿ, ÿêà ñêëàäàºòüñÿ ç çàãàëüíîãî íàáîðó çíàíü, íàâè÷îê òà êîìïåòåíòíîñòåé äëÿ
ï³ñëÿäèïëîìíîãî íàâ÷àííÿ. ϳäêðåñëþºòüñÿ ðîëü ªâðîïåéñüêî¿ Ðàäè ÔÐÌ, ÿê îðãàíó, ñïðÿìîâàíîãî íà çàáåçïå÷åííÿ
íàéâèùèõ ñòàíäàðò³â ìåäè÷íî¿ ï³äãîòîâêè ³ îõîðîíè çäîðîâ’ÿ â ªâðîï³ ³ ãàðìîí³çàö³¿ êâàë³ô³êàö³é ë³êàð³â ÔÐÌ. Äëÿ
óìîæëèâëåííÿ öüîãî áóëè âñòàíîâëåí³ ð³âí³ òåîðåòè÷íèõ çíàíü, íåîáõ³äí³ äëÿ ïðàêòèêè â ñïåö³àëüíîñò³ ÔÐÌ ³ îñíîâí³
êîìïåòåíòíîñò³ (ðåçóëüòàòè ï³äãîòîâêè), ùî ìàþòü áóòè äîñÿãíóò³ íàïðèê³íö³ íàâ÷àííÿ, ³ äîäàíà áàçîâà íàâ÷àëüíà
ïðîãðàìà äëÿ ï³ñëÿäèïëîìíî¿ ï³äãîòîâêè ç ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. Òàêîæ áóëà ïðèä³ëåíà óâàãà äîäèï-
ëîìíîìó íàâ÷àííþ ñòóäåíò³â-ìåäèê³â, ÿêå ââàæàºòüñÿ îáîâ’ÿçêîâèì åëåìåíòîì çðîñòàííÿ ÿê ñïåö³àëüíîñò³ ÔÐÌ, òàê
³ ìåäè÷íî¿ ñï³ëüíîòè â ö³ëîìó, îñîáëèâî, çâàæàþ÷è íà ìàéáóòí³ âèêëèêè ïîïóëÿö³¿, ÿêà ñòàð³º, òà çá³ëüøåííÿ îáìåæåíü
æèòòºä³ÿëüíîñò³ íà íàøîìó êîíòèíåíò³.
Íàðåøò³, ïîêàçàí³ ïðîáëåìè áåçïåðåðâíîãî ïðîôåñ³éíîãî ðîçâèòêó òà ìåäè÷íî¿ îñâ³òè, ùî ³ñíóþòü ó ìàéáóòíüîìó
ºâðîïåéñüêî¿ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè, òà âèçíà÷åíî ðîëü ªâðîïåéñüêî¿ Ðàäè ç àêðåäèòàö³¿ áåçïåðåðâíî¿
ìåäè÷íî¿ îñâ³òè (European Accreditation Council of Continuing Medical Education, EACCME) ªÑÌÑ.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 9. Education and continuous professional development:
shaping the future of PRM. Eur J Phys Rehabil Med. 2018 Apr;54(2):279-286.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 9. Îñâ³òà ³ áåçïåðåðâíèé ïðîôåñ³éíèé ðîçâèòîê:
ôîðìóâàííÿ ìàéáóòíüîãî ÔÐÌ Óêðà¿íñüêèé æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 164–171.
Êëþ÷îâ³ ñëîâà: Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà; ªâðîïà; îñâ³òà, ìåäè÷íà; íàâ÷àëüíà ïðîãðàìà; íàâ÷àííÿ.

Ââåäåííÿ ÔÐÌ, ñòðóêòóðà ³ ä³ÿëüí³ñòü îðãàí³çàö³é ÔÐÌ â

Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî
óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³î-
íàëüíîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòå-
ð³àë³â äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìó-
âàííÿ ïðî ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â
ðåàá³ë³òàö³¿ òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà
âàæëèâîñò³ ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ ñïåö³-
àëüí³ñòþ. Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïîíÿòòÿ
ÔÐÌ, ÷îìó ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì ëþäÿì
³ ñóñï³ëüñòâó, îñíîâè ÔÐÌ, ³ñòîð³ÿ ñïåö³àëüíîñò³
ªâðîï³, çíàííÿ ³ íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà
êë³í³÷íèõ êîìïåòåíòíîñòåé ÔÐÌ, ì³ñöå ñïåö³àëü-
íîñò³ ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ ³ ñóñï³ëü-
ñòâ³, îñâ³òà òà áåçïåðåðâíèé ïðîôåñ³éíèé ðîçâèòîê
ë³êàð³â ÔÐÌ, îñîáëèâîñò³ òà ïðîáëåìè íàóêè òà
äîñë³äæåíü â ÔÐÌ òà ïðîáëåìè òà ïåðñïåêòèâè
ìàéáóòíüîãî ÔÐÌ.
Öåé ðîçä³ë ñòîñóºòüñÿ îñâ³òè ë³êàð³â ÔÐÌ ó
ªâðîï³. Ïðåäñòàâëåíî äåòàëüíó ³íôîðìàö³þ ïðî
îñâ³òó ³ íàâ÷àííÿ ìåäè÷íèõ ñïåö³àë³ñò³â, îáãîâî-
ðåííÿ ñòàíäàðò³â, ùî âèìàãàþòüñÿ íà ºâðîïåé-
ñüêîìó ð³âí³ – íàâ³òü ÿêùî âîíè ïîêè íå º ôàêòè÷-
íîþ ðåàëüí³ñòþ â óñ³õ ºâðîïåéñüêèõ êðà¿íàõ. Òàêîæ
çðîáëåíèé ôîêóñ íà äîäèïëîìí³é îñâ³ò³ ñòóäåíò³â-
ìåäèê³â, ÿêå ââàæàºòüñÿ îáîâ’ÿçêîâèì åëåìåíòîì
çðîñòàííÿ ÿê ñïåö³àëüíîñò³ ÔÐÌ, òàê ³ ìåäè÷íî¿

164 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 9 – ÎѲÒÀ ² ÁÅÇÏÅÐÅÐÂÍÈÉ ÏÐÎÔÅѲÉÍÈÉ ÐÎÇÂÈÒÎÊ: ÔÎÐÌÓÂÀÍÍß ÌÀÉÁÓÒÍÜÎÃÎ ÔÐÌ
ñï³ëüíîòè â ö³ëîìó, îñîáëèâî, çâàæàþ÷è íà ìàé-
áóòí³ âèêëèêè ïîïóëÿö³¿, ÿêà ñòàð³º, òà çá³ëüøåííÿ
îáìåæåíü æèòòºä³ÿëüíîñò³ íà íàøîìó êîíòèíåíò³.
Ïîêàçàí³ ïðîáëåìè áåçïåðåðâíîãî ïðîôåñ³éíîãî
ðîçâèòêó òà ìåäè÷íî¿ îñâ³òè, ùî ³ñíóþòü ó ìàéáóò-
íüîìó ºâðîïåéñüêî¿ ÔÐÌ. Íàðåøò³, äîêëàäíî îïè-
ñàí³ ïðèíöèïè ³ çì³ñò ºâðîïåéñüêî¿ íàâ÷àëüíî¿ ïðî-
ãðàìè.
Îñâ³òà òà íàâ÷àííÿ
Ïðàêòèêà ÔÐÌ ìຠóí³êàëüí³ õàðàêòåðèñòèêè
êîìàíäíîãî, ïàö³ºíò-öåíòðè÷íîãî, ö³ëü-ñïðÿìîâà-
íîãî ï³äõîäó, ùî ìຠçà ìåòó îïòèì³çàö³þ ôóíêö³¿
³ ÿêîñò³ æèòòÿ ïàö³ºíòà, çàïîá³ãàííÿ óñêëàäíåííÿì
³ ï³äâèùåííþ ñóñï³ëüíî¿ ³íòåãðàö³¿. Òîìó ë³êàð³
ÔÐÌ ïîâèíí³ ðîçâèâàòè íå ò³ëüêè ìåäè÷í³ çíàííÿ,
àëå òàêîæ êîìïåòåíòí³ñòü â îáëàñò³ äîïîìîãè ïà-
ö³ºíòàì, ñïåöèô³÷í³ ïðîöåäóðí³ íàâè÷êè ³ ñòàâëåí-
íÿ ùîäî ì³æîñîáèñò³ñíèõ â³äíîñèí ³ êîìóí³êàö³¿,
ãëèáîêå ðîçóì³ííÿ îñíîâíèõ ïðèíöèï³â ìåäè÷íî¿
åòèêè òà ãðîìàäñüêîãî çäîðîâ’ÿ, çäàòí³ñòü çàñòî-
ñîâóâàòè ïðàâèëà äîïîìîãè òà ïðîô³ëàêòèêè
â³äíîñíî äî îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³,
çäàòí³ñòü îñâîþâàòè ñòðàòå㳿 ðå³íòåãðàö³¿ îñ³á ç
îáìåæåííÿìè æèòòºä³ÿëüíîñò³ äî ñóñï³ëüñòâà,
çàñòîñîâóâàòè ïðèíöèïè çàáåçïå÷åííÿ ÿêîñò³ ³
ñïðèÿòè áåçïåðåðâíîìó ïðîôåñ³éíîìó ðîçâèòêó,
ùî ´ðóíòóºòüñÿ íà ïðàêòè÷í³é ä³ÿëüíîñò³.
ßê êåð³âíèêè ìóëüòè-ïðîôåñ³éíèõ ðåàá³ë³òàö³é-
íèõ êîìàíä, çàëó÷åíèõ äî áåçïåðåðâíîãî íàäàííÿ
äîïîìîãè â³ä ë³êàðí³ äî ñï³ëüíîòè, âîíè òàêîæ ïî-
âèíí³ äåìîíñòðóâàòè óïðàâë³íñüê³ êîìïåòåíòíîñò³,
çíàòè ³ çàñòîñîâóâàòè ïðèíöèïè äîêàçîâî¿ ìåäèöè-
íè, âðàõîâóâàòè ì³ðêóâàííÿ ùîäî îá³çíàíîñò³ ïðî
âèòðàòè ³ àíàë³çó ðèçèê-âèãîäà âïðîäîâæ íàäàííÿ
â³äïîâ³äíî¿ äîïîìîãè ïàö³ºíòó òà / àáî íàñåëåííþ.
ÔÐÌ º íåçàëåæíîþ ìåäè÷íîþ ñïåö³àëüí³ñòþ ó
âñ³õ ºâðîïåéñüêèõ êðà¿íàõ, êð³ì Äàí³¿. Âèçíàííÿ ö³º¿
ñïåö³àëüíîñò³ çä³éñíþºòüñÿ â Ðîñ³¿ ³ â Óêðà¿í³ çàâ-
äÿêè 䳿 Ñåêö³¿ òà Ðàäè ÔÐÌ ªÑÌÑ, äåëåãàòè ÿêî¿
Òàáëèöÿ ². Íàçâè ñïåö³àëüíîñò³ Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà â êðà¿íàõ-÷ëåíàõ ªÑÌÑ
Ʉɪɚʀɧɚ ɇɚɡɜɚ ɫɩɟɰɿɚɥɶɧɨɫɬɿ
Ⱥɜɫɬɪɿɹ Physikalische Medizin und allgemeine Rehabilitation
Ȼɟɥɶɝɿɹ Fysische Geneeskunde en Revalidatie
Médecine Physique et de Réadaptation
Ȼɨɫɧɿɹ Fizikalna medicina i rehabilitacija
ɬɚ Ƚɟɪɰɟɝɨɜɢɧɚ
Ȼɨɥɝɚɪɿɹ Ɏɢɡɢɤɚɥɧɚ ɢ ɪɟɯɚɛɢɥɢɬɚɰɢɨɧɧɚ ɦɟɞɢɰɢɧɚ
(Fizikalna i rehabilitacionna medicina)
ɏɨɪɜɚɬɿɹ Fizikalna medicina i rehabilitacija
Ʉɿɩɪ ĭȣıȚțȒ ǿĮIJȡȚțȒ țĮȚ ǹʌȠțĮIJȐıIJĮıȘ
(Fisiki Iatriki & Apokatastasi)
ɑɟɫɶɤɚ Ɋɟɫɩɭɛɥɿɤɚ Rehabilitaþní a fyzikální medicina
Ⱦɚɧɿɹ Fysiurgi
ȿɫɬɨɧɿɹ Taastusravi ja füsiaatria
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
îðãàí³çóâàëè ê³ëüêà îñâ³òí³õ çàõîä³â â ò³ñí³é
ñï³âïðàö³ ç ì³ñöåâèìè ë³êàðÿìè, âèìàãàþ÷è ñòâî-
ðåííÿ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè, ÿê
ïîâíîö³ííî¿ ³ íåçàëåæíî¿ ìåäè÷íî¿ ñïåö³àëüíîñò³.
Ñòàíäàðòè îñâ³òè òà íàâ÷àííÿ ë³êàð³â
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
³äïîâ³äíî äî ïðàâèë ªÑÌÑ, âñòàíîâëåííÿ çà-
ãàëüíîãî íàáîðó çíàíü, íàâè÷îê òà êîìïåòåíòíîñ-
òåé äëÿ ï³ñëÿäèïëîìíîãî íàâ÷àííÿ äîçâîëÿº ñòâî-
ðèòè çàãàëüíó ñòðóêòóðó íàâ÷àííÿ, ùî óìîæëèâèòü
ôàõ³âöÿì ç ö³º¿ äèñöèïë³íè ïåðåñóâàòèñü ç îäí³º¿
êðà¿íè â ³íøó. ³äïîâ³äíî äî ö³ëåé ªÑÌÑ, ªâðî-
ïåéñüêà Ðàäà ÔÐÌ ìຠçà ìåòó çì³öíèòè áåç-
ïå÷í³ñòü òà ÿê³ñòü äîïîìîãè ïàö³ºíòàì øëÿõîì
ðîçðîáêè íàéâèùèõ ñòàíäàðò³â ìåäè÷íîãî íàâ÷àí-
íÿ òà îõîðîíè çäîðîâ’ÿ â ªâðîï³ òà ãàðìîí³çàö³¿
êâàë³ô³êàö³¿ ë³êàð³â ÔÐÌ. Ïðè öüîìó ªâðîïåéñüêà
Ðàäà ÔÐÌ íå ïðàãíå çàì³íèòè êîìïåòåíö³þ íàö³î-
íàëüíèõ îðãàí³â âëàäè ó âèçíà÷åíí³ çì³ñòó ï³ñëÿ-
äèïëîìíîãî íàâ÷àííÿ ó ñâî¿é âëàñí³é êðà¿í³, à ëèøå
äîïîâíèòè ¿õ òà çàáåçïå÷èòè âèñîêó ÿê³ñòü íàâ÷àí-
íÿ â ªâðîï³.
Òðèâàë³ñòü íàâ÷àííÿ
Ùîá çäîáóòè íåîáõ³äíó øèðîêó ñôåðó êîìïå-
òåíòíîñòåé, ñïåö³àë³ñòè ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè ïîâèíí³ ïðîéòè äîáðå îðãàí³çîâàíå ³ íà-
ëåæíèì ÷èíîì ñòðóêòóðîâàíå íàâ÷àííÿ äîñòàòíüî¿
òðèâàëîñò³. ¯õ áàçîâà ìåäè÷íà ï³äãîòîâêà ïîâèí-
íà äàòè ¿ì ïåâí³ êîìïåòåíòíîñò³, ÿê³ ïîñèëþþòü-
ñÿ çàâäÿêè çíàííÿì ³ äîñâ³äó, íàáóòèì ï³ä ÷àñ ¿õ
ñï³ëüíîãî îñíîâíîãî íàâ÷àííÿ ç âíóòð³øíüî¿ ìåäè-
öèíè, îðòîïå䳿, íåâðîëî㳿 òîùî. Çàâäÿêè ð³çíèì
íàö³îíàëüíèì òðàäèö³ÿì òà çàêîíàì, íàçâè òà ôî-
êóñ äëÿ ñïåö³àëüíîñò³ ÔÐÌ âàð³þþòüñÿ, ÿê ³ òðè-
âàë³ñòü íàâ÷àííÿ (äèâ. òàáëèöþ ²). Õî÷à ñåðåäíÿ
òðèâàë³ñòü íàâ÷àííÿ äëÿ âñ³õ ñïåö³àëüíîñòåé ó
ªâðîï³ çðîñëà â ïåð³îä ç 1989 ïî 2013 ðð.1 (Ìàëþ-
íîê 1), â äàíèé ÷àñ â äåÿêèõ ºâðîïåéñüêèõ êðà¿íàõ
Ɍɪɢɜɚɥɿɫɬɶ
5ɪ 3ɦɿɫ.
5ɪ+1ɪ ɫɩɟɰɿɚɥɿɡɚɰɿɹ
4ɪ
4ɪ
4ɪ 4ɦɿɫ
Ɂɚ ɤɨɪɞɨɧɨɦ
2ɪ +3ɪ
--
3ɪ
165
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Ïðîäîâæåííÿ òàáëèö³ I

Ɏɿɧɥɹɧɞɿɹ Fysiatria 5ɪ
Ɏɪɚɧɰɿɹ Médecine Physique et de Réadaptation 4ɪ
ɇɿɦɟɱɱɢɧɚ Physikalische und Rehabilitative Medizin 1ɪ ȼɧɭɬɪɿɲɧɹ ɦɟɞɢɰɢɧɚ / ɇɟɜɪɨɥɨɝɿɹ
1ɪ Ɉɪɬɨɩɟɞɿɹ
+3ɪ ɎɊɆ
Ƚɪɟɰɿɹ ĭȣıȚțȒ ǿĮIJȡȚțȒ țĮȚ ǹʌȠțĮIJȐıIJĮıȘ 5ɪ
(Fisiki Iatriki & Apokatastasi)
ɍɝɨɪɳɢɧɚ Rehabilitációs Medicina 5ɪ
ȱɫɥɚɧɞɿɹ Endurhæfingarlækningar --.
ȱɪɥɚɧɞɿɹ Rehabilitation Medicine 4ɪ
ȱɬɚɥɿɹ Medicina Fisica e Riabilitativa 4ɪ
Ʌɚɬɜɿɹ FizikƗlƗ un rehabilitƗcijas medicƯna 4ɪ
Ʌɢɬɜɚ Fizine medicina ir reabilitacija 4ɪ
Ʌɸɤɫɟɦɛɭɪɝ Médecine Physique et de Réadaptation Ɂɚ ɤɨɪɞɨɧɨɦ
Ɇɚɥɶɬɚ Rehabilitation Medicine Ɂɚ ɤɨɪɞɨɧɨɦ
ɇɿɞɟɪɥɚɧɞɢ Revalidatie Geneeskunde 4ɪ ɡɦɿɧɚ ɧɚ 3ɪ7ɦɿɫ
ɇɨɪɜɟɝɿɹ Fysikalsk medisin og rehabilitering 1ɪ +4ɪ
ɉɨɥɶɳɚ Rehabilitacja Medyczna 5ɪ
ɉɨɪɬɭɝɚɥɿɹ Medicina Física e de Reabilitação 5ɪ
Ɋɭɦɭɧɿɹ Medicină Fizică ‫܈‬i Reabilitare 4ɪ
Ɋɨɫɿɹ - -
Ɋɟɫɩɭғɛɥɿɤɚ ɋɟғɪɛɿɹ Fizikalna Medicina I Rehabilitacija 4ɪ
ɋɥɨɜɚɱɱɢɧɚ Fyziatria, balneológia & lieþebná rehabilitácia 4ɪ
ɋɥɨɜɟɧɿɹ Fizikalna in rehabilitacijska medicina 2ɪ3ɦɿɫ +2ɪ9ɦɿɫ
ȱɫɩɚɧɿɹ Medicina Fisica y Rehabilitación 4ɪ
ɒɜɟɰɿɹ Rehabiliterings Medizin 5ɪ
ɒɜɟɣɰɚɪɿɹ Médecine Physique et de Réadaptation 5ɪ
Physikalische Medizin und Rehabilitation
Medicina Fisica e Riabilitativa
Ɍɭɪɟɱɱɢɧɚ Fiziksel Tip ve Rehabilitasyon 4ɪ (ɦɨɠɟ ɛɭɬɢ ɩɪɨɞɨɜɠɟɧɨ ɞɨ 4.5ɪ)
ɍɤɪɚʀɧɚ Ɏɿɡɢɱɧɚ ɬɚ ɪɟɚɛɿɥɿɬɚɰɿɣɧɚ ɦɟɞɢɰɢɧɚ 4ɪ
ȼɟɥɢɤɚ Ȼɪɢɬɚɧɿɹ Rehabilitation Medicine 4ɪ

ñïîñòåð³ãàºòüñÿ òåíäåíö³ÿ äî çìåíøåííÿ òðèâà-

ëîñò³ íàâ÷àííÿ ç ìåäè÷íî¿ ñïåö³àëüíîñò³ ç â³äïî-
â³äíèõ åêîíîì³÷íèõ òà ñîö³àëüíèõ ïðè÷èí2. Îñâ³ò-
íÿ ïðîãðàìà ç ÔÐÌ â ªâðîï³, çàçâè÷àé,
íàëàøòîâóºòüñÿ â 48-ì³ñÿ÷íîìó ôîðìàò³, â äåÿêèõ
êðà¿íàõ âîíà çá³ëüøóºòüñÿ äî 72 ì³ñÿö³â, âêëþ÷à-
þ÷è ì³í³ìóì 36 ì³ñÿö³â êë³í³÷íîãî íàâ÷àííÿ (ç ÿêèõ
24 ì³ñÿö³ ïðîâîäÿòü ó â³ää³ëåíí³ ÔÐÌ).
Îäíàê, çâàæàþ÷è íà âåëè÷åçíå çá³ëüøåííÿ
î÷³êóâàíî¿ òðèâàëîñò³ æèòòÿ ó âñ³é ªâðîï³ òà ïî-
äàëüøå çá³ëüøåííÿ çàõâîðþâàíü, ùî ïðèçâîäÿòü
äî îáìåæåíü æèòòºä³ÿëüíîñò³ òà ïîâ’ÿçàíèõ ç
â³êîì, ç ãîñòðèì ïî÷àòêîì òà õðîí³÷íèì ïåðåá³ãîì,
÷àñòîòà òà ñêëàäí³ñòü ñóïóòí³õ çàõâîðþâàíü ó
â³ää³ëåííÿõ ðåàá³ë³òàö³¿ çíà÷íî çðîñëè. Ïàö³ºíòè
ãîñï³òàë³çóþòüñÿ ó â³ää³ëåííÿ íàáàãàòî ðàí³øå
ï³ñëÿ ïî÷àòêó ãîñòðî¿ õâîðîáè àáî òðàâìè, ³ òàêîæ
çðîñòຠñêëàäí³ñòü îáìåæåíü æèòòºä³ÿëüíîñò³. Ç
ö³º¿ ïðè÷èíè Ðàäà ÔÐÌ âèñòóïຠçà òðèâàë³ñòü
íàâ÷àííÿ 60 ì³ñÿö³â, âêëþ÷àþ÷è 12-ì³ñÿ÷í³ ðîòàö³¿
Ìàëþíîê 1. Ðîçïîä³ë ñïåö³àëüíîñòåé ç îô³ö³éíîþ òðèâàë³ñòþ
â çîâí³øí³õ â³ää³ëåííÿõ (íàïð. âíóòð³øíÿ ìåäèöè- íàâ÷àííÿ ÿê ìåíø 3, 4 àáî 5 ðîê³â â³äïîâ³äíî, â êðà¿íàõ ªâðîïè:
íà, íåâðîëîã³ÿ, ³íòåíñèâíà òåðàï³ÿ òîùî). Êð³ì òîãî, ðåçóëüòàòè äâîõ îãëÿä³â, ïðîâåäåíèõ â 1989 òà 2013 ðîêàõ1
äëÿ çàáåçïå÷åííÿ ïàö³ºíòàì îïòèìàëüíî¿ äîïîìî-
ãè, î÷³êóºòüñÿ, ùî ðåçèäåíòè ç ÔÐÌ áóäóòü ðîç- íà ïîøóêó, ðîçóì³íí³ ³ âèêîðèñòàíí³ íàéêðàùèõ
âèâàòè çä³áíîñò³ ïðèéìàòè ð³øåííÿ, ´ðóíòóþ÷èñü íàÿâíèõ äîêàç³â. Çà òàêèõ óìîâ ðåêîìåíäóºòüñÿ,

166 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 9 – ÎѲÒÀ ² ÁÅÇÏÅÐÅÐÂÍÈÉ ÏÐÎÔÅѲÉÍÈÉ ÐÎÇÂÈÒÎÊ: ÔÎÐÌÓÂÀÍÍß ÌÀÉÁÓÒÍÜÎÃÎ ÔÐÌ
ùîá ðåçèäåíòàì ç ÔÐÌ ïðîïîíóâàëîñÿ ùîíàéìåí-
øå ø³ñòü ì³ñÿö³â íàâ÷àííÿ ìåòîäàì äîñë³äæåííÿ ÿê
îáîâ’ÿçêîâîãî êîìïîíåíòó ¿õ ï³ñëÿäèïëîìíî¿ îñâ³-
òè. Ðåàá³ë³òàö³ÿ º ñêëàäíîþ ä³ÿëüí³ñòþ, ÿêà çàëå-
æèòü â³ä áàãàòüîõ ôàêòîð³â.  íàóêîâ³é ë³òåðàòóð³
íåîáõ³äíî âèâ÷àòè ³ ïðàêòè÷íî çàñòîñîâóâàòè êîí-
êðåòí³ ìåòîäîëîã³÷í³ ï³äõîäè äëÿ äîñÿãíåííÿ íåîá-
õ³äíèõ ð³âí³â äîêàçîâî¿ ìåäèöèíè, ÿê³ ìîæóòü äîïî-
ìîãòè ñïåö³àëüíîñò³ óñï³øíî ðîçâèâàòèñÿ ³ óñï³øíî
êîíêóðóâàòè â ìàéáóòí³õ åêîíîì³êàõ â ãàëóç³ îõî-
ðîíè çäîðîâ’ÿ. Îòæå, ïîòåíö³éí³ â÷åí³ ïîâèíí³ áóòè
ï³äòðèìàí³ ïðè çä³éñíåíí³ äèñåðòàö³éíèõ ïðîãðàì ó
ï³äðîçä³ë³, çàáåçïå÷åíîìó â³äïîâ³äíèìè øòàòàìè.
Êåð³âíèêè íàâ÷àëüíèõ ïðîãðàì, âèêëàäà÷³
òà íàâ÷àëüí³ ï³äðîçä³ëè
Íàâ÷àííÿ ë³êàð³â ÔÐÌ íåçàëåæí³é ðîáîò³ ïîâ’ÿ-
çàíî ç äîñâ³äîì ³ îáîâ’ÿçêîâî ìຠâ³äáóâàòèñÿ â
êîíòåêñò³ ñèñòåìè íàäàííÿ äîïîìîãè â îõîðîí³
çäîðîâ’ÿ. Íàâ÷àííÿ ïîâèííî çä³éñíþâàòèñÿ â
ñïåö³àë³çîâàíèõ öåíòðàõ, äå äîñòóïí³ êâàë³ô³-
êîâàíèé ïåðñîíàë ³ àäåêâàòí³ ðåñóðñè.
Êåð³âíèê íàâ÷àëüíî¿ ïðîãðàìè ÔÐÌ íåñå ïîâíó
â³äïîâ³äàëüí³ñòü çà íàâ÷àëüíó ïðîãðàìó; â³í/âîíà
çä³éñíþº íàãëÿä òà çàáåçïå÷óº ÿê³ñòü äèäàêòè÷-
íî¿ òà êë³í³÷íî¿ îñâ³òè òà êîíòðîëþº ñóïåðâ³ç³¿
ðåçèäåíò³â íà âñ³õ ëîêàö³ÿõ, ùî áåðóòü ó÷àñòü â íà-
â÷àëüí³é ïðîãðàì³. ³í/âîíà ïîâèíåí äåìîíñòðóâà-
òè åêñïåðòíèé äîñâ³ä â ñïåö³àëüíîñò³ ÔÐÌ ³ áóòè
âèçíàíèé âèêëàäà÷åì ç ÔÐÌ â³äïîâ³äàëüíèì íà-
ö³îíàëüíèì îðãàíîì ó ñâî¿é êðà¿í³. Òàêîæ ðåêîìåí-
äîâàíî, ùîá â³í/âîíà ñÿãíóâ ñòàòóñó âèêëàäà÷à,
ñåðòèô³êîâàíîãî Ðàäîþ ÔÐÌ.
Êîæåí ðåçèäåíò ïîâèíåí îòðèìàòè ñóïåðâ³ç³þ
îäíèì âèêëàäà÷åì (ë³êàðåì ÔÐÌ) ç äîêóìåíòî-
âàíîþ êâàë³ô³êàö³ºþ ç íàâ÷àííÿ òà ñóïåðâ³ç³é ðå-
çèäåíò³â. Âèêëàäà÷³ ïîñò³éíî çàëó÷åí³ äî ðîë³ íà-
ñòàâíèêà, ùîá äîïîìàãàòè ðåçèäåíòàì ðîçâèâàòè
íàâè÷êè, çíàííÿ ³ ñòàâëåííÿ, ÿê³ â³äíîñÿòüñÿ äî
ïðàêòèêè ÔÐÌ, ³ ïðèéìàòè ê³ëüê³ñíó òà ïðîãðåñèâ-
íó â³äïîâ³äàëüí³ñòü çà íàäàííÿ äîïîìîãè êîæíîìó
ïàö³ºíòîâ³.
Îö³íþâàííÿ ðåçóëüòàò³â çàñâîºííÿ/ íàâ÷àííÿ
Äîñÿãíåííÿ ðåçóëüòàò³â çàñâîºííÿ/íàâ÷àííÿ
ïîâèííî îö³íþâàòèñÿ ùîíàéìåíøå ùîð³÷íî êåð³â-
íèêîì íàâ÷àëüíî¿ ïðîãðàìè ðàçîì ç âèêëàäà÷àìè.
Íåîáõ³äíî ïîñò³éíå âåäåííÿ â³äïîâ³äíî¿ äîêóìåí-
òàö³¿ ïðî îö³íêè. Òàêà äîêóìåíòàö³ÿ ïîâèííà áóòè
ó ôàéë³ ðåçèäåíòà, òà âîíà ìຠáóòè äîñòóïíîþ äëÿ
ðåçèäåíòà òà ³íøîãî óïîâíîâàæåíîãî ïåðñîíàëó.
Îö³íêà ïîâèííà áóòè îá’ºêòèâíîþ òà äîêóìåíòó-
âàòè ïðîãðåñèâíå ï³äâèùåííÿ âèêîíàâ÷èõ çä³áíî-
ñòåé ðåçèäåíòà â³äïîâ³äíî äî éîãî îñâ³òíüîãî ð³âíÿ.
Çîêðåìà, ô³íàëüíèé åêçàìåí íà îñòàííüîìó ðîö³
íàâ÷àííÿ ìຠï³äòâåðäèòè, ùî ðåçèäåíò ïîêàçàâ
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
äîñòàòíþ êîìïåòåíòí³ñòü äëÿ ïî÷àòêó ïðàêòèêè áåç
ïðÿìîãî íàãëÿäó. Ïðîòÿãîì ïðîöåñó îö³íþâàííÿ,
ïðàâà ðåçèäåíòà ïîâèíí³ áóòè çàõèùåí³ íàëåæíèìè
ïðîöåñóàëüíèìè ïðîöåäóðàìè. Ðåçèäåíò ìຠçàáåç-
ïå÷óâàòèñü ïèñüìîâîþ ïîë³òèêîþ çàêëàäó ñòîñîâ-
íî éîãî/¿¿ ïðàâ òà îáîâ’ÿçê³â òà ïðàâ çàêëàäó.
Ïðîöåäóðè ñåðòèô³êàö³¿
Ôàõ³âö³ ÔÐÌ ìàþòü ñâîáîäó ïåðåñóâàòèñü â
êðà¿íàõ-÷ëåíàõ ªÑÌÑ, àëå ïîòðåáóþòü ñåðòèô³-
êàö³¿ â³ä ñâî¿õ íàö³îíàëüíèõ íàâ÷àëüíèõ îðãàí³â3. Ò³,
ó êîãî öå º, ìîæóòü áóòè âèçíàí³ ªâðîïåéñüêîþ
Ðàäîþ ÔÐÌ, ÿêà ìຠâñåá³÷í³ ñïåöèô³êàö³¿ ç íà-
ñòóïíèõ àñïåêò³â ï³ñëÿäèïëîìíî¿ îñâ³òè äëÿ ñïå-
ö³àë³ñò³â ÔÐÌ. Âîíè ñêëàäàþòüñÿ ç:
– íàâ÷àëüíî¿ ïðîãðàìè äëÿ ï³ñëÿäèïëîìíî¿ îñâ³-
òè, ùî ì³ñòèòü áàçîâ³ çíàííÿ òà çàñòîñóâàííÿ
ÔÐÌ ïðè ñïåöèô³÷íèõ ñòàíàõ çäîðîâ’ÿ;
– çðàçêó íàâ÷àëüíîãî êóðñó ó â³ää³ëåíí³ ÔÐÌ
òðèâàë³ñòþ ÿêíàéìåíø ÷îòèðè ðîêè, ç äåòàëü-
íîþ ðåºñòðàö³ºþ ä³ÿëüíîñò³ ó îô³ö³éíîìó æóð-
íàë³ ºäèíîãî çðàçêó;
– ºäèíîãî ïèñüìîâîãî ùîð³÷íîãî ³ñïèòó ïî âñ³é
ªâðîï³;
– ñèñòåìè íàö³îíàëüíèõ ìåíåäæåð³â ç íàâ÷àííÿ
òà àêðåäèòàö³¿ äëÿ ñïðèÿííÿ ãàðíèõ êîíòàêò³â ç
ðåçèäåíòàìè â ¿õ êðà¿íàõ;
– ñòàíäàðòíèõ ïðàâèë àêðåäèòàö³¿ âèêëàäà÷³â òà
ïðîöåñó ñåðòèô³êàö³¿;
– êîíòðîëþ ÿêîñò³ íàâ÷àëüíèõ öåíòð³â, ùî ïðî-
âîäèòüñÿ øëÿõîì ¿õ â³äâ³äóâàííÿ àêðåäèòîâà-
íèìè ôàõ³âöÿìè; òà
– áåçïåðåðâíîãî ïðîôåñ³éíîãî ðîçâèòêó â ìåæàõ
îõîïëåííÿ ñèñòåìè áåçïåðåðâíîþ ìåäè÷íîþ
îñâ³òîþ ªÑÌÑ ç ìåòîþ ïîâòîðíî¿ ïåðåâ³ðêè
êîæí³ äåñÿòü ðîê³â.
Á³ëüøå ³íôîðìàö³¿ ùîäî ïðàâèë ö³º¿ ñèñòåìè
îñâ³òè òà íàâ÷àííÿ ìîæëèâî çíàéòè íà âåá-ñàéò³
Ñåêö³¿ ÔÐÌ ªÑÌÑ www.euro-prm.org, äå òàêîæ
äîñòóïí³ ôîðìè çàÿâ.
 òåïåð³øí³é ÷àñ â ªâðîï³ º áëèçüêî 20000
ë³êàð³â ÔÐÌ ³ 3000 ðåçèäåíò³â ÔÐÌ; ñåðåä 3897
ë³êàð³â ÔÐÌ, ÿê³ áóëè ñåðòèô³êîâàí³ ªâðîïåé-
ñüêîþ Ðàäîþ ç 1993 ðîêó, 1094 º àêòèâíèìè ÷ëå-
íàìè ªâðîïåéñüêî¿ ðàäè ÔÐÌ: 260 ç íèõ äîñÿãëè
ñòàòóñó ñòàðøèõ ÷ëåí³â; 24 íàâ÷àëüí³ öåíòðè (ñïè-
ñîê ÿêèõ äîñòóïíèé íà âåá-ñàéò³ çà ïîñèëàííÿì
http://euro-prm.org/certification_docs/TC.htm) º ñåð-
òèô³êîâàíèìè Ðàäîþ öåíòðàìè ç íàâ÷àííÿ ÔÐÌ
â³äïîâ³äíî äî ºâðîïåéñüêîãî ñòàíäàðòó.
Äîäèïëîìíà ï³äãîòîâêà
Ìåíåäæìåíò çàõâîðþâàííÿ – öå êîìàíäíèé
àñïåêò ìåäè÷íî¿ ïðàêòèêè, ÿêèé º ïàö³ºíò – öåíò-
ðè÷íèì, ñïðÿìîâàíèì íà äîñÿãíåííÿ ö³ëåé òà ç ìå-
òîþ îïòèì³çàö³¿ ôóíêö³îíóâàííÿ òà ÿêîñò³ æèòòÿ
167
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ïàö³ºíòà, çàïîá³ãàííÿ óñêëàäíåííÿì òà çá³ëüøåí-
íÿ ñóñï³ëüíî¿ ó÷àñò³. Ìåäè÷í³ ñòóäåíòè áóäóòü
â³äïîâ³äàòè çà äîïîìîãó õâîðèì ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ òà îñîáàì ç³ ñòàíàìè, ÿê³ ïðèçâî-
äÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³, íåçàëåæíî â³ä
òîãî, â ÿêó ãàëóçü âîíè õî÷óòü óâ³éòè, ÿê ï³ñëÿäèï-
ëîìí³ ðåçèäåíòè.  äàíèé ÷àñ ïàö³ºíòè, ÿêèõ ë³êó-
þòü ïðàêòè÷íî âñ³ ñïåö³àëüíîñò³, âèÿâëÿþòü ïîòðå-
áó ó ðåàá³ë³òàö³¿, êîëè ìè ââàæàºìî, ùî ëþäè â
äàíèé ÷àñ âèæèâàþòü â³ä òîãî, ùî ðàí³øå áóëî
ñìåðòåëüíîþ õâîðîáîþ, àëå òåïåð âîíè çàëèøà-
þòüñÿ áîðîòèñÿ ç ïîðóøåííÿìè òà îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ àáî, êðàùå ñêàçàòè, ç îáìåæåí-
íÿìè ¿õ àêòèâíîñò³ òà ìîæëèâîñò³ ó÷àñò³4.
 ðåçóëüòàò³, âñ³ ë³êàð³ ïîâèíí³ îòðèìàòè áàçîâ³
çíàííÿ ïðî ðåàá³ë³òàö³þ, âèçíàþ÷è, ùî á³ëüø³ñòü
íå áóäóòü ïðàöþâàòè, ÿê ñïåö³àë³ñòè â ö³é ãàëóç³,
àáî çä³éñíþâàòè ñïåöèô³÷íó ðåàá³ë³òàö³éíó
ä³ÿëüí³ñòü. Òîìó âàæëèâî, ùîá äîáðå íàâ÷åí³ ë³êàð³
ÔÐÌ íàâ÷àëè ô³çè÷í³é òà ðåàá³ë³òàö³éí³é ìåäèöèí³
íà âñ³õ äîäèïëîìíèõ ìåäè÷íèõ ôàêóëüòåòàõ, òà
íàñòóïí³ òåìè º ì³í³ìàëüíî íåîáõ³äíèìè:
– ïðèíöèïè ÔÐÌ òà á³î-ïñèõî-ñîö³àëüíà ìîäåëü
̳æíàðîäíî¿ êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ, îá-
ìåæåíü æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ;
– îðãàí³çàö³ÿ òà ïðàêòèêà ÔÐÌ (ãîñòðà òà ï³äãî-
ñòðà ðåàá³ë³òàö³ÿ, à òàêîæ ðåàá³ë³òàö³éí³ ïðîãðà-
ìè äëÿ ïàö³ºíò³â ç õðîí³÷íèìè ñòàíàìè);
– ïðèíöèïè òà ö³ë³ ôóíêö³îíàëüíîãî îö³íþâàííÿ òà
îñíîâí³ íåñïðèÿòëèâ³ ôàêòîðè ôóíêö³îíàëüíîãî
â³äíîâëåííÿ;
– ïðèíöèïè òà ïîòåíö³àë ô³çè÷íî¿ òåðàﳿ, åðãîòå-
ðàﳿ, (íåéðî)ïñèõîëî㳿, òåðàﳿ ìîâè òà ìîâëåííÿ
òà ³íøèõ ðåàá³ë³òàö³éíèõ òåðàï³é;
– ïðèíöèïè òà ðåçóëüòàòè ìåäèêàìåíòîçíîãî
ë³êóâàííÿ äëÿ ïîë³ïøåííÿ ôóíêö³é, çàïîá³ãàííÿ
óñêëàäíåíü, ïîëåãøåííÿ áîëþ àáî áóäü-ÿêîãî
³íøîãî äæåðåëà äèñêîìôîðòó;
– êîìïëåêñí³ ðåàá³ë³òàö³éí³ ïðîãðàìè òà îñíîâí³
ïîêàçè äî íèõ;
– ðåàá³ë³òàö³éí³ ïîòðåáè ïàö³ºíò³â ç îñîáëèâèìè
ñòàíàìè (íàïð. ³íñóëüò, ìíîæèííà òðàâìà, ïî-
ïåðåêîâèé á³ëü, àðòðèò, ðàê òîùî);
– çíàííÿ ñîö³àëüíî¿ ñèñòåìè òà çàêîíîäàâñòâà, ùî
ñòîñóºòüñÿ îáìåæåíü æèòòºä³ÿëüíîñò³ òà ðåà-
á³ë³òàö³¿ íà íàö³îíàëüíîìó ð³âí³, à òàêîæ àñïåê-
òè åòèêè òà ïðàâ ëþäèíè â ðåàá³ë³òàö³¿.
Ö³ ïîíÿòòÿ âæå º ÷àñòèíîþ îáîâ’ÿçêîâîãî íà-
â÷àííÿ ç ÔÐÌ â á³ëüøîñò³ ºâðîïåéñüêèõ êðà¿í.
ªâðîïåéñüêà Ðàäà ÔÐÌ âèçíà÷èëà ÿäðî äëÿ äî-
äèïëîìíî¿ íàâ÷àëüíî¿ ïðîãðàìè ç ïðàêòè÷íèìè
íàâè÷êàìè ³ âèçíà÷åííÿì ïåð³îäó íàâ÷àííÿ ó
â³ää³ëåíí³ ÔÐÌ. Ó ïëàí³ ä³é ªâðîïåéñüêî¿ Ðàäè
ÔÐÌ 2014-2018 íàäàºòüñÿ åëåêòðîííà êíèãà, ùî
ï³äòðèìóº òàêèé íàâ÷àëüíèé ïëàí.
168 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Áåçïåðåðâíèé ïðîôåñ³éíèé ðîçâèòîê (ÁÏÐ)
òà ìåäè÷íà îñâ³òà (ÁÌÎ)
 ³íòåðåñàõ áåçïåêè ïàö³ºíò³â òà äîïîìîãè ãàð-
íî¿ ÿêîñò³ âñ³ ë³êàð³ ìàþòü çîáîâ’ÿçàííÿ çàéìàòè-
ñÿ áåçïåðåðâíîþ îñâ³òîþ, òðåí³íãàìè òà íàâ÷àí-
íÿì ïðîòÿãîì óñüîãî æèòòÿ, äëÿ ï³äòðèìêè
íàëåæíî¿ ïðîôåñ³éíî¿ ïðàêòèêè. Ãàðàíò³ÿ ÿêîñò³ ìàº
ïðîäåìîíñòðóâàòè, ùî íàö³îíàëüí³ ñòàíäàðòè º
ïîð³âíÿëüíèìè ç ì³æíàðîäíèìè ñòàíäàðòàìè.
Ó öüîìó ãëîáàëüíîìó êîíòåêñò³ áåçïåðåðâíèé ïðî-
ôåñ³éíèé ðîçâèòîê (ÁÏÐ) ìຠâðàõîâóâàòè ì³æ-
íàðîäí³ ³ííîâàö³¿ òà ãàðí³ ïðàêòèêè, âèìàãàþ÷è,
ùîá óñ³ ïðàêòèêóþ÷³ ë³êàð³ ïîñò³éíî âäîñêîíà-
ëþâàëèñÿ, íàáóâàëè íîâèõ íàâè÷îê òà çàáåçïå÷óâà-
ëè ïîíîâëåííÿ ³ñíóþ÷èõ ïðàêòèê íîâèìè äîêàçàìè
³ íàñòàíîâàìè, ÿê ò³ëüêè âîíè ñòàþòü äîñòóïíèìè.
Öå ïîâèííî êîíòðîëþâàòèñÿ ³ ï³äòðèìóâàòèñÿ
íàö³îíàëüíèìè ðåãóëÿòîðíèìè îðãàíàìè.
³äïîâ³äíî äî âèùåçàçíà÷åíèõ âèìîã, ÁÏÐ òà
áåçïåðåðâíà ìåäè÷íà îñâ³òà (ÁÌÎ) º íåâ³ä’ºìíîþ
÷àñòèíîþ ïðîôåñ³éíî¿ ïðàêòèêè ë³êàð³â ÔÐÌ. Âñ³
ë³êàð³ ÔÐÌ ïîâèíí³ äåìîíñòðóâàòè ñâîþ áåçïåðåð-
âíó êîìïåòåíòí³ñòü. Öå ïîâèííî áóòè ïðîçîðèì,
ï³äçâ³òíèì, ï³ääàâàòèñü ðåãóëþâàííþ òà êîðèñíèì
äëÿ çàáåçïå÷åííÿ ÿêîñò³ â ïðîöåñ³ ï³äòðèìêè ïî-
âòîðíî¿ ñåðòèô³êàö³¿.
ÁÏÐ ñêëàäàºòüñÿ ç óñ³õ íàâ÷àëüíèõ çàñîá³â
ïîíîâëåííÿ, ðîçâèòêó òà ïîñèëåííÿ òîãî, ÿê ë³êàð³
çàñòîñîâóþòü çíàííÿ, âì³ííÿ, ñòàâëåííÿ (âêëþ÷à-
þ÷è ïîâåä³íêè òà åòè÷í³ ñòàíäàðòè), ùî íåîáõ³äí³
äëÿ ¿õ ïðîôåñ³éíîãî æèòòÿ. ÁÏÐ, íàïð., âêëþ÷àº
çàõîäè ç³ çì³öíåííÿ ðîçáóäîâè êîìàíä, óïðàâë³ííÿ,
ïðîôåñ³îíàë³çìó, ì³æîñîáèñò³ñíî¿ êîìóí³êàö³¿, ³íôîð-
ìàö³éíèõ òåõíîëîã³é, íàâ÷àííÿ, äîñë³äæåíü, åêñïåð-
òíî¿ îö³íêè, àóäèòó ³ ï³äçâ³òíîñò³. Ó öüîìó ñåíñ³
ÁÏÐ âêëþ÷ຠ³ âèõîäèòü çà ðàìêè ÁÌÎ (êë³í³÷í³
çíàííÿ); îäíàê êðåäèòè ÁÌÎ ìîæóòü ðîçãëÿäàòè-
ñÿ, ÿê ïðîñòèé ñïîñ³á çàëó÷åííÿ äî ÁÌÎ/ÁÏÐ, òà
ÿê çàãàëüíà «âàëþòà ÁÌλ. ªÑÌÑ ãàðìîí³çóâà-
ëà àêðåäèòàö³þ ÁÌÎ íàâêîëî ºâðîïåéñüêèõ êðå-
äèò³â ÁÌÎ (ªÊÁÌÎ), ùî ìîæå áóòè âèêîðèñòàíî
â óñ³é ªâðîï³, à òàêîæ ÷åðåç óãîäó ïðî âçàºìíå
âèçíàííÿ ç Àìåðèêàíñüêîþ ìåäè÷íîþ àñîö³àö³ºþ,
òàêîæ â ϳâí³÷í³é Àìåðèö³. Àìåðèêàíñüêà Ðàäà ç
Ô³çè÷íî¿ ìåäèöèíè òà ðåàá³ë³òàö³¿ (ÀÐÔÌÐ) º
îäí³ºþ ç 24 Ðàä ç ìåäè÷íèõ ñïåö³àëüíîñòåé, ÿê³
ñêëàäàþòü Àìåðèêàíñüêó Ðàäó Ìåäè÷íèõ Ñïåö-
³àëüíîñòåé (ÀÐÌÑ)5. Ìåòîþ ÀÐÌÑ º çàõèñò ãðî-
ìàäñüêîñò³ øëÿõîì âñòàíîâëåííÿ çàãàëüíèõ ñòàí-
äàðò³â äëÿ ë³êàð³â äëÿ äîñÿãíåííÿ òà ï³äòðèìêè
ñåðòèô³êàö³¿ ðàäîþ â ¿õ â³äïîâ³äíèõ ñïåö³àëüíîñòÿõ.
ÀÐÌÑ îö³íþº òà ñåðòèô³êóº ë³êàð³â, ÿê³ â³äïîâ³äà-
þòü ïåâíèì âèìîãàì ùîäî îñâ³òè òà ï³äãîòîâêè.
AÐÔÌÐ âñòàíîâëþº âèìîãè äî ñåðòèô³êàö³¿ òà
¹2(2) *2018
 ÐÎÇÄ²Ë 9 – ÎѲÒÀ ² ÁÅÇÏÅÐÅÐÂÍÈÉ ÏÐÎÔÅѲÉÍÈÉ ÐÎÇÂÈÒÎÊ: ÔÎÐÌÓÂÀÍÍß ÌÀÉÁÓÒÍÜÎÃÎ ÔÐÌ
ï³äòðèìêè ñåðòèô³êàö³¿, ñòâîðþº ñâî¿ ³ñïèòè, ïðàã-
íå ïîë³ïøèòè ï³äãîòîâêó òà äîëó÷àºòüñÿ äî âñòà-
íîâëåííÿ ñòàíäàðò³â äëÿ ô³çè÷íî¿ ìåäèöèíè òà
ðåàá³ë³òàö³¿ (äèâ. www.abms.org).
ªâðîïåéñüêà Ðàäà ç àêðåäèòàö³¿ áåçïåðåðâíî¿
ìåäè÷íî¿ îñâ³òè ªÑÌÑ (EACCME)® º ï³äðîçä³ëîì
ªÑÌÑ, ÿêèé ôîðìàëüíî ïðåäñòàâëÿº ºâðîïåéñüê³
êðà¿íè: òîìó éîãî êðåäèòè âèçíàþòüñÿ íàö³îíàëü-
íèìè îðãàíàìè àêðåäèòàö³¿, ÿê äîäàòêîâ³, íåêîíêó-
ðåíòí³ äëÿ ñâ êîìïåòåíö³¿ ³ ä³ÿëüíîñò³. ªâðî-
ïåéñüê³ ïîëîæåííÿ º îäíàêîâèìè äëÿ âñ³õ
ñïåö³àëüíîñòåé. EACCME â³äïîâ³äຠçà êîîðäèíà-
ö³þ ñâ ä³ÿëüíîñò³ ç óñ³õ ìåäè÷íèõ ñïåö³àëüíî-
ñòåé, à âåá-ñàéò ªÑÌÑ ì³ñòèòü äåòàëüí³ â³äîìîñò³
ùîäî âèìîã áåçïåðåðâíî¿ ìåäè÷íî¿ îñâ³òè äëÿ âñ³õ
ìåäè÷íèõ ñïåö³àëüíîñòåé â ªâðîï³ (äèâ.
www.uems.org). Îáîâ’ÿçêîâ³ ÁÏÐ / ÁÌÎ âñòàíîâ-
ëåí³ â äåÿêèõ êðà¿íàõ ªâðîïè òà ñòàþòü âñå á³ëüø
íåîáõ³äíèìè ó ìåäè÷í³é ïðàêòèö³. Ñõåìè ïðîôå-
ñ³éíèõ êîìïåòåíòíîñòåé - öå ôîðìàëüí³ ñòðóêòó-
ðè, ùî çàáåçïå÷óþòüñÿ äåðæàâàìè-÷ëåíàìè äëÿ
ãàðàíòóâàííÿ, ùî êîìïåòåíòíîñò³ ðåºñòðîâàíèõ
ôàõ³âö³â ï³äòðèìóþòüñÿ íà áàæàíîìó ð³âí³. Êîæåí
ë³êàð çîáîâ’ÿçàíèé ðåºñòðóâàòèñÿ çà òàêîþ ñõå-
ìîþ. Íà íàö³îíàëüíîìó ð³âí³ ö³ êðà¿íè ðîçðîáèëè
âëàñí³ ïðàâèëà, ³ á³ëüø³ñòü ç íèõ ìàþòü îáîâ’ÿç-
êîâ³ âèìîãè. Äåÿê³ êðà¿íè çðîáèëè ¿õ çàêîíîäàâ÷è-
ìè âèìîãàìè. Ðàäà ÔÐÌ ñòâîðèëà Êîì³òåò ÁÏÐ/
ÁÌÎ, ÿêèé íåñå â³äïîâ³äàëüí³ñòü çà â³äïîâ³äí³ áåç-
ïåðåðâí³ ïðîãðàìè â ðàìêàõ íàøî¿ ñïåö³àëüíîñò³,
çà àêðåäèòàö³þ ê³ëüêîõ íàóêîâèõ çàõîä³â íà ºâðî-
ïåéñüêîìó ð³âí³ òà íàóêîâèé ñòàòóñ ë³êàð³â ÔÐÌ,
ùî ñåðòèô³êîâàí³ Ðàäîþ. ̳æíàðîäí³ íàâ÷àëüí³
ïðîãðàìè ñëóãóþòü äëÿ íàâ÷àííÿ ë³êàð³â ÔÐÌ òà
¿õ êîëåã â ðåàá³ë³òàö³éíèõ êîìàíäàõ; âîíè ïîêðè-
âàþòü òåìè ôóíäàìåíòàëüíèõ íàóê òà êë³í³÷íîãî
íàâ÷àííÿ, à òàêîæ äîñë³äíèöüê³ òà òåõí³÷í³ ïðîãðà-
ìè. Ïðîãðàìà ÁÌÎ/ÁÏÐ, ÿêà îðãàí³çîâàíà íà ºâðî-
ïåéñüêîìó ð³âí³ äëÿ àêðåäèòàö³¿ ì³æíàðîäíèõ êîí-
ãðåñ³â òà çàõîä³â ÔÐÌ, áàçóºòüñÿ íà ïîëîæåííÿõ
âçàºìíî¿ óãîäè, ï³äïèñàíî¿ ì³æ EACCME òà Ñåê-
ö³ºþ òà Ðàäîþ ÔÐÌ ªÑÌÑ, ÿêà îïóáë³êîâàíà íà
âåá-ñàéò³ Ðàäè (http: /www.euro-prm.org/index.
php?option=com_content&view=article&id=
23&Itemid=168&lang=en)
³äïîâ³äíî äî ö³º¿ âçàºìíî¿ óãîäè íàö³îíàëüíèì
îðãàíîì àêðåäèòàö³¿ êîæíî¿ äåðæàâè-÷ëåíà ªÑ (òà
EªÏ) º:
– â³äïîâ³äíèé îðãàí, ÿêèé êåðóº òà êîíòðîëþº
àêðåäèòàö³þ ë³êàð³â, ùî ïðàöþþòü ó ö³é êðà¿í³,
³ âèçíà÷ຠê³ëüê³ñòü íåîáõ³äíèõ êðåäèò³â;
– íåñå â³äïîâ³äàëüí³ñòü çà â³äïîâ³äí³ ïðîãðàìè â
ðàìêàõ ñïåö³àëüíîñò³, çà àêðåäèòàö³þ íàóêîâèõ
çàõîä³â íà ºâðîïåéñüêîìó ð³âí³ òà íàóêîâèé ñòà-
òóñ ë³êàð³â ÔÐÌ, ñåðòèô³êîâàíèõ Ðàäîþ.
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Êîæíà Ðàäà âèçíàëà, ùî ë³êàð ÔÐÌ ïîòðåáóº
îòðèìàííÿ 250 îñâ³òí³õ êðåäèò³â ïðîòÿãîì ï’ÿòè-
ð³÷íîãî ïåð³îäó ç ìåòîþ ïîâòîðíîãî ï³äòâåðäæåí-
íÿ êâàë³ô³êàö³¿ (www.euro-prm.org). Êðåäèòè ìî-
æóòü áóòè îòðèìàí³ çà äîïîìîãîþ ð³çíèõ çàõîä³â
ÁÌÎ, âêëþ÷àþ÷è ïàñèâíó àáî àêòèâíó ó÷àñòü ó
íàóêîâèõ çàõîäàõ, ïóáë³êàö³¿ â æóðíàëàõ/êíèãàõ,
àêàäåì³÷í³ âèäè àêòèâíîñò³ (íàïð. PhD) òà ñàìî-
îñâ³òó (øëÿõîì îñîáèñòî¿ ï³äïèñêè íà æóðíàëè
ÔÐÌ àáî äîêóìåíòîâàíå â³äâ³äóâàííÿ íàâ÷àëüíèõ
³íòåðíåò-êóðñ³â ç ÔÐÌ). ³äïîâ³äíî äî ïðàâèë
ªÑÌÑ Ðàäà ÔÐÌ âèçíàº, ùî äîñÿãíóòî çíà÷íèõ
óñï³õ³â â ìåòîäîëîã³ÿõ çàáåçïå÷åííÿ ÁÌÎ òà ÁÏÐ,
çà äîïîìîãîþ ÿêèõ ö³ îñâ³òí³ ìîæëèâîñò³ º äîñòóï-
íèìè äëÿ ë³êàð³â. Òîìó âîíà ï³äòâåðäæóº âèêîðè-
ñòàííÿ íîâèõ ìåä³à-çàñîá³â äëÿ íàäàííÿ ÁÌÎ/
ÁÏÐ, ÿê³ âèõîäÿòü çà ìåæ³ òðàäèö³éíèõ ëåêö³é, ñèì-
ïîç³óì³â òà êîíôåðåíö³é. ˳êàð³ çîáîâ’ÿçàí³ âèêî-
íóâàòè âèìîãè ÁÌÎ ïåðåä òèì, ÿê ¿õ ìîæíà áóäå
ïåðåâ³ðèòè, ³ öå ñòຠíåâ³ä’ºìíîþ ÷àñòèíîþ ÿê íà-
ö³îíàëüíîãî, òàê ³ ºâðîïåéñüêîãî æèòòÿ.
Ðàäà ÔÐÌ òàêîæ áåðå íà ñåáå â³äïîâ³äàëüí³ñòü
çà ðîçøèðåííÿ ìîæëèâîñòåé îñâ³òè äëÿ ðåçèäåíò³â
òà ìîëîäèõ ë³êàð³â ÔÐÌ øëÿõîì ô³íàíñóâàííÿ
ì³æíàðîäíèõ íàâ÷àëüíèõ ïðîãðàì òà ðîçïîâñþä-
æåííÿ íàâ÷àëüíèõ ìàòåð³àë³â. Ùå ëèøå ç îãëÿäó
íà 2015 ð³ê, Ðàäîþ ÔÐÌ àêðåäèòîâàíî 18 ì³æíà-
ðîäíèõ êóðñ³â, ùî íàäàëî ìîæëèâ³ñòü îòðèìàííÿ
293 êðåäèò³â ÁÌÎ.
Ïåðøèì çàõîäîì, ùî ñïîíñîðóâàëà ªâðîïåéñü-
êà Ðàäà, áóëà ªâðîïåéñüêà øêîëà â Ìàðñåë³ ç àíà-
ë³çó ïîñòóðè ³ ðóõó, ÿêà áóëà ñòâîðåíà â 2000 ðîö³.
Öå º ùîð³÷íèì äâîòèæíåâèì êóðñîì, ÿêèé çàëó÷àº
ë³êàð³â, ³íæåíåð³â òà ³íøèõ ôàõ³âö³â ðåàá³ë³òàö³¿ ç
óñ³º¿ ªâðîïè. Ó 2005 ðîö³ â Ñèðàêóçàõ áóëî ðîçïî-
÷àòî ªâðî-ñåðåäçåìíîìîðñüêó ë³òíþ øêîëó ðåà-
á³ë³òàö³¿. Öå ùîð³÷íèé íàâ÷àëüíèé êóðñ âèñîêîãî
ð³âíÿ ç ðåàá³ë³òàö³éíî¿ òåìàòèêè, ÿêèé áåçêîøòîâ-
íî ïðîïîíóºòüñÿ 40 ðåçèäåíòàì ÔÐÌ ç êðà¿í-÷ëåí³â
ªÑÌÑ òà êðà¿í Ñåðåäçåìíîìîð’ÿ.
ʳëüêà åëåêòðîííèõ êíèã ç íàâ÷àëüíèì âì³ñòîì
áóëè îïóáë³êîâàí³ òà ðîçïîâñþäæåí³ áåçêîøòîâíî
äëÿ áàãàòüîõ ÷ëåí³â òà ðåçèäåíò³â.  äàíèé ÷àñ
âîíè äîñòóïí³ äëÿ çàâàíòàæåííÿ ç âåá-ñàéòó Ðàäè
(http://www.euro-prm.org/index.php?option=com_
content&view=article&id=28&Itemid=178&lang=en)
Íàâ÷àëüíà ïðîãðàìà ç ÔÐÌ:
îñíîâí³ ïðèíöèïè
гçí³ ñôåðè êîìïåòåíòíîñòåé òà âòðó÷àíü
ë³êàð³â ÔÐÌ çàçâè÷àé îïèñóþòüñÿ çà êàòåãîð³ÿìè
ç óðàõóâàííÿì îñíîâíèõ ìåäè÷íèõ ñòàí³â àáî ïî-
ðóøåíü ñèñòåì îðãàí³çìó. Ôàêòè÷íî, ìåäèöèíà
ãîñòðî¿ äîïîìîãè / çàãàëüíà ìåäèöèíà çîñåðåäæå-
169
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
íà â îñíîâíîìó íà îðãàíàõ, çàõâîðþâàííÿõ òà ìå-
õàí³çìàõ ïîøêîäæåííÿ, ÿê³ ´ðóíòóþòüñÿ íà ìîäåë³
ìåäèöèíè ̳æíàðîäíî¿ êëàñèô³êàö³¿ õâîðîá - ÌÊÕ.
Öå âïëèâຠíà ñïîñ³á êàòåãîðèçàö³¿ ïàö³ºíò³â, ùî
âèõîäèòü äàëåêî çà ìåæ³ ìåäè÷íîãî ñâ³òó. Öå íå
º îïòèìàëüíèì äëÿ çîñåðåäæåíî¿ íà ôóíêö³¿ ìåäè÷-
íî¿ ñïåö³àëüíîñò³, òàêî¿, ÿê ÔÐÌ6. Íàâïàêè, ñôåðà
êîìïåòåíòíîñòåé òà âòðó÷àííÿ ë³êàð³â ÔÐÌ ïî-
âèíí³ áóòè ïåðåðàõîâàí³ ç âèêîðèñòàííÿì êàòåãîð³é,
ïîâ’ÿçàíèõ ç ôóíêö³ºþ, íà îñíîⳠ̳æíàðîäíî¿ êëà-
ñèô³êàö³¿ ôóíêö³îíóâàííÿ, îáìåæåíü æèòòºä³ÿëü-
íîñò³ òà çäîðîâ’ÿ – ÌÊÔ. Çã³äíî ç ö³ºþ ìîäåëëþ,
ë³êàð³ ÔÐÌ ïîòðåáóþòü:
– çíàíü á³îïñèõîñîö³àëüíèõ äåòåðì³íàíò çäîðîâ’ÿ
òà êîìïëåêñíî¿ âçàºìî䳿 ôàêòîð³â, ùî îáìå-
æóþòü ó÷àñòü òà àâòîíîì³þ îñ³á ç îáìåæåííÿ-
ìè æèòòºä³ÿëüíîñò³ ó êîíòåêñò³ ¿õ ìåäè÷íîãî
ñòàíó;
– íàÿâíîñò³ âì³ííÿ ïîâ³äîìèòè öå ïàö³ºíòó, ðîäèí³
ïàö³ºíòà, êîëåãàì òà ðåàá³ë³òàö³éí³é êîìàíä³,
äëÿ çàáåçïå÷åííÿ åôåêòèâíîãî êîìá³íîâàíîãî
ï³äõîäó, ÿêèé çîñåðåäæóºòüñÿ íà êîíêðåòíèõ
ïð³îðèòåòàõ ïàö³ºíòà;
– äåìîíñòðóâàííÿ ïàö³ºíò-öåíòðè÷íî¿ êë³í³÷íî¿
ïðàêòèêè ç àêöåíòîì íà îö³íþâàííÿ, ïëàíóâàí-
íÿ òà íàâ÷àííÿ â ò³ñíîìó êîíòàêò³ ç ÷ëåíàìè
êîìàíäè òà â ðàìêàõ êóëüòóðè óìîæëèâëåííÿ
òà óïðàâë³ííÿ ðèçèêàìè.
Çà òàêîþ ïåðåäóìîâîþ, êîìïåòåíòíîñò³, ÿê³
áóäóòü íàáóò³ ï³ä ÷àñ íàâ÷àííÿ àáî, ÿê î÷³êóºòü-
ñÿ, äî ê³íöÿ íàâ÷àííÿ, âêëþ÷àþòü:
– êë³í³÷íå òà ³íñòðóìåíòàëüíå îö³íþâàííÿ äëÿ
âèçíà÷åííÿ ïàòîô³ç³îëîã³÷íèõ ìåõàí³çì³â òà îñ-
íîâíîãî ä³àãíîçó ñòàíó ïàö³ºíòà;
– çíàííÿ ïðèíöèï³â íàâ÷àííÿ / íåéðîïëàñòè÷íîñò³
/ ðåïàðàö³¿ / â³äíîâëåííÿ;
– ôóíêö³îíàëüíå îö³íþâàííÿ â ðàìêàõ ÌÊÔ,
âêëþ÷àþ÷è îö³íþâàííÿ ïîðóøåíü ôóíêö³é/
ñòðóêòóð îðãàí³çìó, îö³íþâàííÿ îáìåæåíü àê-
òèâíîñò³ òà îáìåæåíü ìîæëèâîñò³ ó÷àñò³ òà
ðîçð³çíåííÿ ì³æ çäàòí³ñòþ òà âèêîíàííÿì, âè-
õîäÿ÷è ç âèÿâëåííÿ êîíòåêñòóàëüíèõ (îñîáèñ-
òèõ õàðàêòåðèñòèê) òà ñåðåäîâèùíèõ áàð’ºð³â/
ñïðèÿòëèâèõ ÷èííèê³â;
– âïðîâàäæåííÿ ³íñòðóìåíò³â êë³í³÷íîãî òà
³íñòðóìåíòàëüíîãî îö³íþâàííÿ äëÿ äîñë³äæåí-
íÿ ðóõîâèõ, êîãí³òèâíèõ, ïîâåä³íêîâèõ òà âåãå-
òàòèâíèõ ôóíêö³é;
– ïðîãíîç ïåðåá³ãó çàõâîðþâàííÿ/îáìåæåííÿ
æèòòºä³ÿëüíîñò³, âèÿâëåííÿ íåñïðèÿòëèâèõ/
ñïðèÿòëèâèõ ôàêòîð³â ôóíêö³îíàëüíîãî â³äíîâ-
ëåííÿ òà âèçíà÷åííÿ ñïîñîá³â (øëÿõ³â) â³äíîâ-
ëåííÿ, êîìïåíñàö³¿ òà àäàïòàö³¿;
– ðîçðîáêó ³ ïðîâåäåííÿ ïëàíó ðåàá³ë³òàö³¿ çà äî-
ïîìîãîþ êîìàíäíîãî ï³äõîäó, ÿêèé ñêëàäàºòü-
170 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ñÿ ç âñòàíîâëåííÿ äîñÿæíèõ êîðîòêî-, ñåðåä-
íüî- òà äîâãîñòðîêîâèõ ö³ëåé, óçãîäæåíèõ ç
ïàö³ºíòîì ³ äîãëÿäà÷åì, ³ ÿêèé â ê³íöåâîìó
ï³äñóìêó ïðèçâåäå äî ðå³íòåãðàö³¿ ïàö³ºíòà äî
ñóñï³ëüñòâà ³ ïîë³ïøåííþ ÿêîñò³ æèòòÿ;
– ïðèçíà÷åííÿ ìàêñèìàëüíî çàñíîâàíèõ íà äîêà-
çàõ, íàñê³ëüêè ìîæëèâî, ìåäè÷íèõ ³ ô³çè÷íèõ
âòðó÷àíü (âêëþ÷àþ÷è ìåäèêàìåíòîçíå ë³êó-
âàííÿ, ô³çè÷í³ ìîäàëüíîñò³, ³ííîâàö³éí³ òåõíî-
ëî㳿, ïðèðîäí³ ôàêòîðè òîùî), à òàêîæ òåõí³÷íèõ
çàñîá³â (îðòåç³â, ïðîòåç³â, â³çê³â òîùî), åôåê-
òèâíèõ äëÿ äîñÿãíåííÿ ö³ëåé ðåàá³ë³òàö³éíîãî
ïëàíó;
– ïðîô³ëàêòèêó òà ìåíåäæìåíò óñêëàäíåíü;
– íàâè÷êè êåð³âíèöòâà ³ âèêëàäàííÿ, íåîáõ³äí³ äëÿ
êîîðäèíàö³¿ ³ âèçíà÷åííÿ ïð³îðèòåò³â ðîáîòè
êîìàíäè;
– êîìóí³êàòèâí³ íàâè÷êè, íåîáõ³äí³ äëÿ ïåðåäà÷³
â³äïîâ³äíî¿ ³íôîðìàö³¿ òà ïîÿñíåíü ïàö³ºíòîâ³/
äîãëÿäà÷àì, êîëåãàì, ùî â³äïîâ³äàëüí³ çà ïà-
ö³ºíòà, òà ³íøèì ôàõ³âöÿì îõîðîíè çäîðîâ’ÿ, ç
ìåòîþ ñï³ëüíî¿ ó÷àñò³ â ïëàíóâàíí³ òà âïðîâàä-
æåíí³ áåçïåðåðâíî¿ äîïîìîãè â îõîðîí³ çäîðî-
â’ÿ â³ä ïî÷àòêîâî¿ ñòà䳿 äî ï³äãîñòðîãî ³ ñòà-
á³ëüíîãî ñòàíó;
– çîáîâ’ÿçàííÿ âèêîíóâàòè ïðîôåñ³éí³ îáîâ’ÿçêè
³ äîòðèìóâàòèñü åòè÷íèõ ïðèíöèï³â, ïðîÿâëÿòè
ñï³â÷óòòÿ, ÷åñí³ñòü òà ïîâàãó äî ³íøèõ; ÷óé-
í³ñòü äî ïîòðåá ïàö³ºíò³â, ïîâàãó äî êîíô³äåí-
ö³éíîñò³ òà àâòîíî쳿 ïàö³ºíò³â, ÷óòëèâ³ñòü ³
÷óéí³ñòü äî ð³çíèõ ãðóï ïàö³ºíò³â, âêëþ÷àþ÷è,
àëå íå îáìåæóþ÷èñü, ð³çíîìàí³òí³ñòþ ñòàò³,
â³êó, êóëüòóðè, ðàñè, ðåë³ã³¿, îáìåæåíü æèòòº-
ä³ÿëüíîñò³ òà ñåêñóàëüíî¿ îð³ºíòàö³¿;
– àêòèâíå ñï³âðîá³òíèöòâî ç äåðæàâíèìè àãåíö³-
ÿìè îõîðîíè çäîðîâ’ÿ òà ³íøèìè îðãàíàìè, çà-
ëó÷åíèìè äî ñèñòåìè îõîðîíè çäîðîâ’ÿ;
– âèÿâëåííÿ ïîòðåá îõîðîíè çäîðîâ’ÿ ãðîìàäè òà
âïðîâàäæåííÿ â³äïîâ³äíèõ çàõîä³â, ñïðÿìîâàíèõ
íà çáåðåæåííÿ ³ çì³öíåííÿ çäîðîâ’ÿ òà çäîðî-
âîãî ñïîñîáó æèòòÿ òà çàïîá³ãàííÿ çàõâîðþ-
âàíü;
– ïðîâåäåííÿ ïðîãðàì òåðàïåâòè÷íîãî íàâ÷àííÿ
äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà
äîãëÿäà÷³â;
– ó÷àñòü ó íàâ÷àíí³ ë³êàð³â òà ³íøèõ ôàõ³âö³â, ùî
çàëó÷åí³ äî äîïîìîãè îñîáàì ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³.
– âïðîâàäæåííÿ óñâ³äîìëåííÿ âàðòîñò³ òà àíàë³-
çó ðèçèê-âèãîäà âïðîäîâæ íàäàííÿ äîïîìîãè
ïàö³ºíòàì òà/àáî íàñåëåííþ;
– çäàòí³ñòü ï³äâèùóâàòè ÿê³ñòü ïðîôåñ³éíî¿ ä³ÿëü-
íîñò³ øëÿõîì áåçïåðåðâíîãî íàâ÷àííÿ òà ñàìî-
îö³íêè, óïðàâë³ííÿ ïðàêòèêîþ òà êàð’ºðîþ ç
ìåòîþ ïðîôåñ³éíîãî ðîçâèòêó;
¹2(2) *2018
 ÐÎÇÄ²Ë 9 – ÎѲÒÀ ² ÁÅÇÏÅÐÅÐÂÍÈÉ ÏÐÎÔÅѲÉÍÈÉ ÐÎÇÂÈÒÎÊ: ÔÎÐÌÓÂÀÍÍß ÌÀÉÁÓÒÍÜÎÃÎ ÔÐÌ

– çäàòí³ñòü çàñòîñîâóâàòè îñíîâí³ ïðèíöèïè äî- ϳñëÿäèïëîìíà íàâ÷àëüíà ïðîãðàìà ç ÔÐÌ

ñë³äæåíü, â òîìó ÷èñë³ ïðàâèëà ïðîâåäåííÿ òà
îö³íêè äîñë³äæåíü, ïîÿñíåííÿ ïàö³ºíòàì ³ çàñ-
òîñóâàííÿ â ïðàêòè÷í³é ä³ÿëüíîñò³.
Ç òî÷êè çîðó ï³äõîäó, îð³ºíòîâàíîãî íà çàõâî-
ðþâàííÿ, ë³êàð³ ÔÐÌ ïîâèíí³ ðîçâèâàòè ïðîãðåñèâ-
íó â³äïîâ³äàëüí³ñòü ó ä³àãíîñòèö³, îö³íþâàíí³ òà
óïðàâë³íí³ ñòàíàìè, ÿê³ ÷àñòî çóñòð³÷àþòüñÿ ó ðåà-
á³ë³òàö³éíîìó ìåíåäæìåíò³ ïàö³ºíò³â áóäü-ÿêîãî
â³êó â íàñòóïíèõ ñôåðàõ:
– ãîñòð³ ³ õðîí³÷í³ ì’ÿçîâî-ñêåëåòí³ ñèíäðîìè,
âêëþ÷íî ³ç ñïîðòèâíèìè òà ïðîôåñ³éíèìè òðàâ-
ìàìè, ðåâìàòîëîã³÷íèìè çàõâîðþâàííÿìè,
äîïîìîãîþ ï³ñëÿ ïåðåëîì³â òà ï³ñëÿ îïåðàö³é
àðòðîïëàñòèêè ñóãëîá³â;
– ãîñòð³ ³ õðîí³÷í³ áîëüîâ³ ñòàíè, âêëþ÷íî ³ç âèêî-
ðèñòàííÿì ìåäèêàìåíò³â, ô³çè÷íèõ ìîäàëüíî-
ñòåé, ô³çè÷íèõ âïðàâ, ë³êóâàëüíèõ òà ä³àãíîñòè÷-
íèõ ³í’ºêö³é òà ïñèõîëîã³÷íîãî òà ïðîôåñ³éíîãî
êîíñóëüòóâàííÿ;
– âðîäæåí³ àáî íàáóò³ àìïóòàö³¿;
– ³íñóëüò;
– âðîäæåíà àáî íàáóòà ÷åðåïíî-ìîçêîâà òðàâìà;
– âðîäæåí³ àáî íàáóò³ ðîçëàäè ñïèííîãî ìîçêó;
– âðîäæåí³ àáî íàáóò³ ì³îïàò³¿, ïåðèôåðè÷í³ íåé-
ðîïàò³¿, çàõâîðþâàííÿ ìîòîíåéðîí³â òà ðóõîâî¿
ñèñòåìè òà ³íø³ íåðâîâî-ì’ÿçîâ³ çàõâîðþâàííÿ;
– ëåãåíåâ³, ñåðöåâ³, îíêîëîã³÷í³, ³íôåêö³éí³, ³ìóíî-
ñóïðåñèâí³ òà ³íø³ çàãàëüí³ ìåäè÷í³ ñòàíè, ÿê³
ñïîñòåð³ãàþòüñÿ ó ïàö³ºíò³â ç ô³çè÷íèìè îáìå-
æåííÿìè æèòòºä³ÿëüíîñò³ àáî òèõ, õòî çàçíàº
ñòàí³â, ùî ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëü-
íîñò³;
– òêàíèíí³ ðîçëàäè, òàê³ ÿê äîïîìîãà ïðè âè-
ðàçêàõ òà ðàíàõ;
– ìåäè÷íå êîíäèö³îíóâàííÿ, ðåêîíäèö³îíóâàííÿ
òà ô³òíåñ;
– ìåòàáîë³÷í³ ñòàíè.
äåòàë³çóº òåîðåòè÷í³ çíàííÿ, íåîáõ³äí³ äëÿ ïðàê-
òè÷íî¿ ä³ÿëüíîñò³ â ìåäè÷í³é ñïåö³àëüíîñò³ «Ô³çè÷-
íà òà ðåàá³ë³òàö³éíà ìåäèöèíà» òà îñíîâíèõ êîì-
ïåòåíòíîñòåé (ðåçóëüòàò³â íàâ÷àííÿ), ÿê³ ñë³ä
äîñÿãòè íàïðèê³íö³ íàâ÷àííÿ.
Õî÷à øëÿõ³ ïî÷àòêó íàâ÷àííÿ âàð³þþòüñÿ â
ð³çíèõ êðà¿íàõ ªâðîïè, íàâ÷àëüíà ïðîãðàìà ìàº
áàãàòî ñï³ëüíîãî íà êîíòèíåíò³ ³ â³äïîâ³äຠâèìîãàì
Àìåðèêàíñüêî¿ Ðàäè (äèâ. âåá-ñàéò www.abprm.org
äëÿ äîâ³äêè) àáî ³íøèõ ïðîãðàì ñòàðøî¿ ðåçèäåí-
òóðè ç ðåàá³ë³òàö³éíî¿ ìåäèöèíè (http: // www.
singhealthresidency.com.sg/Pages/Rehabilitation
Medicine.aspxhttp://www.singhealthresidenc.com.sg/
Pages/RehabilitationMedicine.aspx).
Ïîñèëàííÿ
1. Duchatteau D.C., Rol M. Van Der, Smit Jongbloed L.J., Jong
EM De, Vos P. Eindrapportage Quickscan Opleidingsduur en
Bekostiging Medisch Specialistische Vervolgopleidingen in de
EU. 2013.
2. Kiekens C., Moyaert M., Ceravolo M.G., Moslavac S.,
Juocevicius A., Christodoulou N., et al. Education of physical
and rehabilitation medicine specialists across Europe: a call
for harmonization. Eur J Phys Rehabil Med. 2016 Dec;
52(6):881–6.
3. The European Parliament and the Council of the European
Union. Directive 2005/36/EC of the European Parliament and
of the Council of 7 September 2005 on the recognition of
professional qualifications. Off J Eur Union. 2005; 22–142.
4. Ward A.B., Gutenbrunner C., Damjan H., Giustini A.,
Delarque A. European Union of Medical Specialists (UEMS)
section of Physical & Rehabilitation Medicine: a position
paper on physical and rehabilitation medicine in acute settings.
J Rehabil Med. 2010 May;42(5):417–24.
5. American Board of Physical Medicine and Rehabilitation.
Curriculum of Knowledge [Internet]. Available from: https:/
/www.abpmr.org/partI/documents/PartIOutline_Weights.pdf
6. Wade D. Rehabilitation – a new approach. Part four: a new
paradigm, and its implications. Clin Rehabil. 2016 Feb;
30(2):109–18.

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Maria Gabriella
Ceravolo, Pedro Cantista, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner, Carlotte Kiekens,
Sasa Moslavac, Enrique Varela-Donoso, Anthony B Ward, Mauro Zampolini, Stefano Negrini.
• Ó÷àñíèêè: Maria Gabriella Ceravolo, Wim G.M. Janssen, Jacinta McElligott, Angela McNamara, Calogero
Foti, Sasa Moslavac, Raquel Valero, Enrique Varela-Donoso, Rolf Frischknecht, Alvydas Juocevicius,
Rochelle T. Dy, Alain Yelnik.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 171
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

(ÔÐM) â ªâðîï³.
Ðîçä³ë 10 – Íàóêà òà äîñë³äæåííÿ ó ÔÐÌ: îñîáëèâîñò³
òà ïðîáëåìè
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
Ó êîíòåêñò³ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ), öåé äîêóìåíò ïðèñâÿ÷åíèé äîñë³äæåííÿì,
ìàéáóòíüîìó ÔÐÌ. Ñòóäåíòè òà ñïåö³àë³ñòè ÔÐÌ ïåðåâàæíî çàëó÷åí³ äî á³îìåäè÷íèõ äîñë³äæåíü, âèâ÷àþ÷è á³î-
ëîã³÷í³ ïðîöåñè, ïðè÷èíè çàõâîðþâàíü, ¿õ ìåäè÷í³ ä³àãíîçè, îö³íêó ¿õ íàñë³äê³â äëÿ ôóíêö³îíóâàííÿ, îáìåæåíü æèòòº-
ä³ÿëüíîñò³ òà çäîðîâ’ÿ òà âïëèâ âòðó÷àíü â ãàëóç³ îõîðîíè çäîðîâ’ÿ íà îñîáèñòîìó òà ñóñï³ëüíîìó ð³âíÿõ.
Á³ëüø³ñòü ñó÷àñíèõ äîñë³äæåíü ç ÔÐÌ, ÷àñòî ì³æäèñöèïë³íàðíèõ, ïîõîäèòü â³ä ïðèêëàäíèõ äîñë³äæåíü, ÿê³, ç âèêîðè-
ñòàííÿì ³ñíóþ÷èõ çíàíü, ñïðÿìîâàí³ íà ñïåöèô³÷í³ ö³ë³. Ó ö³é îáëàñò³ ïðîâîäÿòüñÿ òðàíñëÿö³éí³ ìåäè÷í³ äîñë³äæåííÿ,
äîñë³äæåííÿ ³ ðîçðîáêè, äîñë³äæåííÿ âïðîâàäæåííÿ ³ äîñë³äæåííÿ êë³í³÷íîãî âïëèâó. ˳êàð³ ÔÐÌ, ïåðåâàæíî ìàã³ñò-
ðè àáî äèñåðòàíòè, â äàíèé ÷àñ çá³ëüøóþòü ñâîþ ó÷àñòü ó ôóíäàìåíòàëüíèõ äîñë³äæåííÿõ òà â äîêë³í³÷íèõ âèïðîáó-
âàííÿõ.
˳êàð³ ÔÐÌ çàëó÷åí³ äî ïåðâèííèõ äîñë³äæåíü, ÿê³ º îðèã³íàëüíèìè äîñë³äæåííÿìè ç ïåðøîãî äæåðåëà, àëå òàêîæ
³ âòîðèííèõ äîñë³äæåíü, ÿê³ º àíàë³çîì òà ³íòåðïðåòàö³ºþ ïóáë³êàö³é ïåðâèííèõ äîñë³äæåíü ó ïåâí³é ñôåð³ ç âèêîðè-
ñòàííÿì ñïåöèô³÷íî¿ ìåòîäîëî㳿.
Âòîðèíí³ äîñë³äæåííÿ çàëèøàþòüñÿ âàæëèâîþ àêòèâí³ñòþ Ñåêö³¿ ÔÐÌ ªÑÌÑ ³ öå áóäå ñôåðîþ íîâîñòâîðåíî¿ Cochrane
Rehabilitation. Âòîðèíí³ äîñë³äæåííÿ ç çàö³êàâëåí³ñòþ äî îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³, áóäóòü ðîçâèâàòèñÿ
â óñüîìó ñâ³ò³ íà ´ðóíò³ äîêàçîâî¿ ìåäèöèíè çà ó÷àñòþ ë³êàð³â ÔÐÌ ³ âñ³õ ³íøèõ ôàõ³âö³â îõîðîíè çäîðîâ’ÿ ³ ñîö³àëüíî¿
ñôåðè, ÿê³ çàëó÷åí³ äî ðåàá³ë³òàö³¿.
 ªâðîï³ ðîçâèòîê äîñë³äíî¿ ä³ÿëüíîñò³ ç ³íòåðåñîì äî ÔÐÌ º âèêëèêîì ìàéáóòíüîãî, òà ç íèì ìè ñòèêàºìîñÿ âæå
çàðàç. ªâðîïåéñüê³ øêîëè ÔÐÌ, ºâðîïåéñüê³ ìàã³ñòåðñüê³ òà äèñåðòàö³éí³ ïðîãðàìè ç ¿õ ìîæëèâîñòÿìè ï³äòðèìêè
äîñë³äíèöüêèõ òà êë³í³÷íèõ çàêëàä³â, ºâðîïåéñüê³ îðãàí³çàö³¿ ÔÐÌ ç ¿õ âåá-ñàéòàìè, íàóêîâ³ æóðíàëè ÔÐÌ òà ºâðî-
ïåéñüê³ êîíãðåñè, ðàçîì ç íàøîþ ñï³âïðàöºþ ç ºâðîïåéñüêèìè äîñë³äíèìè öåíòðàìè âèñîêîãî ð³âíÿ, ºâðîïåéñüêèìè òà
ì³æíàðîäíèìè íàóêîâèìè òîâàðèñòâàìè â ð³çíèõ ãàëóçÿõ º ïîòóæíîþ áàçîþ äëÿ ðîçâèòêó äîñë³äíèöüêî¿ ä³ÿëüíîñò³
ðàçîì ³ç ðîçâèòêîì Êîêðàí³âñüêî¿ ðåàá³ë³òàö³éíî¿ ñôåðè. ÔÐÌ áóäå ë³äåðîì ó ö³é ãàëóç³ äîñë³äæåíü.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 10. Science and research in PRM: specificities and challenges.
Eur J Phys Rehabil Med. 2018 Apr;54(2):287-310.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 10. Íàóêà òà äîñë³äæåííÿ ó ÔÐÌ: îñîáëèâîñò³
òà ïðîáëåìè. Óêðà¿íñüêèé æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè. 2018; 2(2) äîä. Ñ. 172–195.
Êëþ÷îâ³ ñëîâà : Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà, ªâðîïà, á³îìåäè÷í³ äîñë³äæåííÿ, ôóíäàìåíòàëüí³ äîñë³äæåííÿ,
òðàíñëÿö³éí³ ìåäè÷í³ äîñë³äæåííÿ.

Ââåäåííÿ ëþäÿì ³ ñóñï³ëüñòâó, îñíîâè ÔÐÌ, ³ñòîð³ÿ ñïå-

Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî
óõâàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³î-
íàëüíîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòå-
ð³àë³â äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìó-
âàííÿ ïðî ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â
ðåàá³ë³òàö³¿ òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà
âàæëèâîñò³ ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ
ñïåö³àëüí³ñòþ. Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïî-
íÿòòÿ ÔÐÌ, ÷îìó ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì
ö³àëüíîñò³ ÔÐÌ, ñòðóêòóðà ³ ä³ÿëüí³ñòü îðãàí³çàö³é
ÔÐÌ â ªâðîï³, çíàííÿ ³ íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà
êë³í³÷íèõ êîìïåòåíòíîñòåé ÔÐÌ, ì³ñöå ñïåö³àëü-
íîñò³ ÔÐÌ â ñèñòåì³ îõîðîíè çäîðîâ’ÿ ³ ñóñï³ëü-
ñòâ³, îñâ³òà òà áåçïåðåðâíèé ïðîôåñ³éíèé ðîçâèòîê
ë³êàð³â ÔÐÌ, îñîáëèâîñò³ òà ïðîáëåìè íàóêè ³ äîñ-
ë³äæåíü â ÔÐÌ òà ïðîáëåìè ³ ïåðñïåêòèâè ìàé-
áóòíüîãî ÔÐÌ.
Íàóêà ³ äîñë³äæåííÿ â ô³çè÷í³é òà ðåàá³ë³òàö³é-
íî¿ ìåäèöèíè º â³äíîñíî ìîëîäèìè, ÿê ³ ñïåö³-
àëüí³ñòü, ³ ìàþòü äåÿê³ ñïåöèô³÷í³ ïðîáëåìè ³ îñîá-
ëèâîñò³. Öåé ðîçä³ë ïî÷èíຠïðåäñòàâëÿòè
íàóêîâèé ñïåêòð â ÔÐÌ ç ìîæëèâîþ îðãàí³çàö³ºþ
äîñë³äæåíü ôóíêö³îíóâàííÿ òà ðåàá³ë³òàö³¿, ïåðå-
ãëÿäîì òåì ì³æíàðîäíèõ êîíãðåñ³â ³ æóðíàë³â ç

172 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 10 – ÍÀÓÊÀ ÒÀ ÄÎÑ˲ÄÆÅÍÍß Ó ÔÐÌ: ÎÑÎÁËÈÂÎÑÒ² ÒÀ ÏÐÎÁËÅÌÈ
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè, à òàêîæ çàó-
âàæóº, ÿê ïîñèëèòè ðåàá³ë³òàö³éí³ äîñë³äæåííÿ.
ϳñëÿ öüîãî äàºòüñÿ ðåòåëüíèé ³ ïîâíèé îïèñ ñó-
÷àñíî¿ ñèòóàö³¿ ç íàóêîâî¿ òà äîñë³äíèöüêî¿ ä³ÿëü-
íîñò³, ùî ïðåäñòàâëÿº ³íòåðåñ äëÿ Ô³çè÷íî¿ òà Ðå-
àá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ) â ªâðîï³, ç ïîãëÿäîì
íà íîâ³ ìîæëèâîñò³ ³ ïðîáëåìè. Âèçíà÷åíà âàæ-
ëèâ³ñòü ðåàá³ë³òàö³éíèõ äîñë³äæåíü, òà îáãîâî-
ðþºòüñÿ ¿õ ñïåöèô³÷íà ìåòîäîëîã³ÿ, ïîâ’ÿçàíà ç
ïðîáëåìîþ ïîäîëàííÿ ðîçðèâó ì³æ á³îëî㳺þ ³ ïî-
âåä³íêîþ, çâåðòàþ÷è óâàãó íà òàê³ òåìè, ÿê âçàº-
ìîçâ’ÿçîê ì³æ á³îìåäèöèíîþ òà ÔÐÌ (íàóêà º
øèðøå, í³æ á³îëîã³ÿ) ³ äîñë³äæåííÿ ç ÔÐÌ (îäíà ³
òà æ ãðà, ð³çí³ ïðàâèëà, äâ³ ñòîðîíè îäí³º¿ ³ ò³º¿ æ
ìîíåòè). Ïðåäñòàâëåí³ âèêëèêè, ïîâ’ÿçàí³ ç äîêà-
çîâîþ ìåäèöèíîþ â ÔÐÌ, ïî÷èíàþ÷è ç ñó÷àñíî¿
ñèòóàö³¿ òà ïðîïîçèö³é, ùîäî øëÿõ³â âèð³øåííÿ öèõ
ïðîáëåì: çàïðîïîíîâàí³ çàñîáè ï³äâèùåííÿ ñòàí-
äàðò³â âèïðîáóâàíü â ÔÐÌ, ñòâîðåííÿ îá´ðóíòî-
âàíèõ ñïåöèô³÷íèõ äëÿ ÔÐÌ äèçàéí³â âèïðîáóâàíü
òà ñòàíäàðòèçàö³¿ âòðó÷àíü; íàïðèê³íö³ çâåðíåíà
óâàãà íà ïðåäñòàâíèöòâî ÔÐÌ â «ñâ³ò³ äîêàçîâî¿
ìåäèöèíè» òà ïåðåäà÷ó íàóêîâèõ çíàíü äî êë³í³÷íî¿
ïðàêòèêè. Îñòàíí³ ï³äðîçä³ëè çîñåðåäæåí³ íà äî-
ñë³äíèöüê³é ï³äãîòîâö³ òà îñâ³ò³.
Íàóêîâèé ñïåêòð ÔÐÌ
Ñïåêòð íàóêîâî-äîñë³äíî¿ ä³ÿëüíîñò³ â ÔÐÌ
ìîæå áóòè îïèñàíèé â³äïîâ³äíî äî íàâ÷àëüíî¿ ïðî-
ãðàìè Ðàäè ÔÐÌ ªÑÌÑ, ñôåðè êîìïåòåíòíîñòåé
Ñåêö³¿ ÔÐÌ ªÑÌÑ, òåì ³ ïðîãðàì êîíãðåñ³â
ªÒÔÐÌ òà ISPRM, îïóáë³êîâàíèõ â æóðíàëàõ
ÔÐÌ1, 2 ³ ïåðåðàõîâàíèõ ó Êîêðàí³âñüê³é ðåàá³ë³-
òàö³éí³é ñôåð³3.
Îðãàí³çàö³ÿ äîñë³äæåíü ôóíêö³îíóâàííÿ
òà ðåàá³ë³òàö³¿ ëþäèíè
Ñôåðà êîìïåòåíòíîñòåé äëÿ ÔÐÌ – ÿê îïèñà-
íî â êîíöåïòóàëüíîìó îïèñ³ ÔÐÌ4,5 òà ïðåäñòàâ-
ëåíî â ºâðîïåéñüê³é íàâ÷àëüí³é ïðîãðàì³ ç ÔÐÌ6,
âèìàãຠðîçðîáêè ì³öíî¿ íàóêîâî¿ áàçè äëÿ øèðî-
êîãî êîëà ð³çíèõ, àëå ïîâ’ÿçàíèõ ç íåþ íàóêîâèõ
ñôåð. Ìàëþíîê äåìîíñòðóº ñòðóêòóðó ð³çíèõ íà-
óêîâèõ ñôåð, ïî÷èíàþ÷è ç «â³ä êë³òèíè äî ñóñ-
ï³ëüñòâà», à òàêîæ â³ä ôóíäàìåíòàëüíèõ äî ïðè-
êëàäíèõ ³ êë³í³÷íèõ íàóê7,8. Áàçîâîþ êîíöåïö³ºþ,
ÿêà º îñíîâîþ ö³º¿ êîíöåïòóàë³çàö³¿ îêðåìèõ íàó-
êîâèõ ñôåð ó ö³é ñòðóêòóð³, º ³íòåãðàòèâíà ïðèðî-
äà ôóíêö³îíóâàííÿ òà ìîäåëü ÌÊÔ.
Ñïèñêè òåì Êîíãðåñó: ïðåäñòàâëåííÿ
ñïåêòðó ñó÷àñíî¿ íàóêè
Êîíöåïòóàëüíà ñòðóêòóðà ðåàá³ë³òàö³éíîãî äîñ-
ë³äæåííÿ, ÿê ïîêàçàíî íà Ìàëþíêó, º êîðèñíîþ
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ìàëþíîê 1. Öå çîáðàæóº âçàºìîçâ’ÿçêè òðüîõ êîìïîíåíò³â,
ùî ôîðìóþòü êîíöåïö³þ äîêàçîâî¿ ìåäèöèíè.
Armstrong, E.C. (2003) Harnessing new technologies while
preserving basic values. Fam Sys & Health, (21)4, 351-355
â³äïðàâíîþ òî÷êîþ äëÿ âèçíà÷åííÿ êîíêðåòíèõ
íàóêîâèõ òåì. Êîíêðåòíèì çàñòîñóâàííÿì ö³º¿
ñòðóêòóðè º ïåðåë³ê íàóêîâèõ òåì äëÿ êîíãðåñ³â
ÔÐÌ, ÿêèé âïåðøå áóâ ðîçðîáëåíèé òà ïîñò³éíî
îíîâëþþòüñÿ ªÒÔÐÌ 9-11. Âèêîðèñòîâóþ÷è öåé
ï³äõ³ä, ISPRM12 òàêîæ ðîçðîáèâ ñïèñîê íàóêîâèõ
òåì, ùî º êîðèñíèìè äëÿ êîíãðåñ³â ÔÐÌ. Ñïèñîê
íàóêîâèõ òåì ISPRM íàäຠïîâíå óÿâëåííÿ ïðî
ñïåêòð íàóê äëÿ ÔÐÌ. Îñê³ëüêè íàóêà º äèíà-
ì³÷íîþ, ñïèñîê òåì ðåãóëÿðíî îíîâëþºòüñÿ ç óðà-
õóâàííÿì ïîÿâè íîâèõ íàóêîâèõ ï³äõîä³â òà ïð³î-
ðèòåò³â òà âèëó÷åííÿ ï³äõîä³â, ÿê³ âæå íå º
êîðèñíèìè. ¥ðóíòóþ÷èñü íà äîñâ³ä³ îñòàíí³õ ñâ³òî-
âèõ êîíãðåñ³â ISPRM ó Áåðë³í³ 2015 ðîêó òà Êóà-
ëà-Ëóìïóð³ â 2016 ðîö³, áóëî ðîçðîáëåíî îíîâëå-
íèé ñïèñîê íàóêîâèõ òåì11. Äîäàòîê 1 äåìîíñòðóº
ñó÷àñíèé ñïèñîê òåì.
Äîìîâëåí³ñòü æóðíàë³â ç ÔÐÌ
Ïóáë³êàö³ÿ íàóêîâèõ äîñë³äæåíü ï³ñëÿ ðåòåëü-
íîãî ïåðåãëÿäó åêñïåðòàìè â³ä³ãðຠâàæëèâó ðîëü
äëÿ ïðîöåñó äîñë³äæåííÿ, à òàêîæ âïðîâàäæåííÿ
äîñë³äæåíü äî ïðàêòèêè òà ïðîôåñ³éíî¿ ä³ÿëüíîñò³,
çàñíîâàíî¿ íà äîêàçàõ13. Ó âçàºìî䳿 ç òîâàðèñòâà-
ìè òà êîíãðåñàìè, æóðíàëè ÔÐÌ ôîðìóþòü ðîçó-
ì³ííÿ òîãî, ùî ñòàíîâèòü íàóêîâó ñôåðó ÔÐÌ. Öå
ïîñèëþº ³äåíòèô³êàö³þ â÷åíèõ âñåðåäèí³ ÔÐÌ òà
âèäèì³ñòü ö³º¿ íàóêîâî¿ ñôåðè äëÿ òèõ, õòî çíàõî-
äèòüñÿ ïîçà ìåæàìè ÔÐÌ. Òîìó æóðíàëè ç ÔÐÌ,
ÿê³ êîíêóðóþòü â íàóêîâ³é ñôåð³, ìàþòü ñï³ëüíó
çàö³êàâëåí³ñòü ïðîñóâàòè ïðîöåñ äîñë³äæåíü. ßê ³
ªÒÔÐÌ 14 , ISPRM òàêîæ ðîçðîáèëà ìåðåæó
ñï³âïðàöþþ÷èõ æóðíàë³â ç ÔÐÌ, ùî êîîðäèíóþòü-
ñÿ êîì³òåòîì ç ïóáë³êàö³é15.
173
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Çì³öíåííÿ ðåàá³ë³òàö³éíèõ äîñë³äæåíü:
ôîðìóâàííÿ ìàéáóòíüîãî íàóêè â ÔÐÌ
Äîñë³äæåííÿ ôóíêö³îíóâàííÿ ëþäèíè òà ðåàá³-
ë³òàö³¿ ìàþòü âåëè÷åçíèé ïîòåíö³àë, ùîá ñòàòè
áàãàòîãðàííîþ, ïîñë³äîâíîþ äîñë³äíèöüêîþ ñôå-
ðîþ, â ÿê³é äîñë³äíèêè ç ð³çíèõ äèñöèïë³í ãåíåðó-
þòü òà ³íòåãðóþòü íîâ³ çíàííÿ òà êîîðäèíóþòü
çóñèëëÿ äëÿ âèâ÷åííÿ îïòèì³çàö³¿ ôóíêö³îíóâàííÿ
òà ÿêîñò³ æèòòÿ ëþäåé, ùî çàçíàþòü îáìåæåíü
æèòòºä³ÿëüíîñò³8,16. Ðåàë³çàö³ÿ öüîãî ïîòåíö³àëó
ïîòðåáóº ïîñèëåííÿ äîñë³äíèöüêî¿ çäàòíîñò³ òà
çá³ëüøåííÿ ô³íàíñóâàííÿ äîñë³äæåíü8,17. Âàæëèâ³
ï³äõîäè âêëþ÷àþòü îñâ³òó òà íàâ÷àííÿ äîñë³ä-
íèê³â, ðîçâèòîê ñïåö³àë³çîâàíèõ äîñë³äíèõ óñòàíîâ,
íàö³îíàëüíèõ òà ì³æíàðîäíèõ ìåðåæ ñï³âïðàö³ òà
ì³æäèñöèïë³íàðíèõ óí³âåðñèòåòñüêèõ öåíòð³â18, à
òàêîæ ðîçøèðåííÿ ³ñíóþ÷èõ òà ñòâîðåííÿ íîâèõ
àêàäåì³÷íèõ íàâ÷àëüíèõ ïðîãðàì ç ÔÐÌ19.
Íîâîþ ³ âàæëèâîþ ³í³ö³àòèâîþ ùîäî çì³öíåííÿ
äîêàçîâî¿ áàçè äëÿ ÔÐÌ º ðîçðîáêà Êîêðàí³âñüêî¿
ðåàá³ë³òàö³éíî¿ ñôåðè20. Îñê³ëüêè îïòèì³çàö³ÿ ôóí-
êö³îíóâàííÿ º ìåòîþ ðåàá³ë³òàö³¿, â³äïîâ³äíå çàñòî-
ñóâàííÿ ÌÊÔ ÿê ç êîíöåïòóàëüíî¿, òàê ³ ç ìåòîäî-
ëîã³÷íî¿ òî÷êè çîðó º îñíîâîþ äëÿ ö³º¿ ³í³ö³àòèâè21.
Ö³ çóñèëëÿ ùîäî ïîñèëåííÿ íàóêîâî- äîñë³ä-
íèöüêî¿ çäàòíîñò³ º âàæëèâèìè ôàêòîðàìè ìàéáóò-
íüîãî íàóêè ó ÔÐÌ.
Ìàëþíîê. Îêðåì³ íàóêîâ³ îáëàñò³ â äîñë³äæåí-
íÿõ ôóíêö³îíóâàííÿ ëþäèíè òà ðåàá³ë³òàö³¿. Öåé
ìàëþíîê ³ëþñòðóº â³äíîñèíè â ïðîöåñ³ êîìóí³êàö³¿
íàóêîâèõ çíàíü ì³æ ð³çíèìè íàóêîâèìè ñôåðàìè.
Ïîäâ³éí³ ñòð³ëêè âêàçóþòü íà òå, ùî çíàííÿ ìîæóòü
ïåðåäàâàòèñü â îáîõ íàïðÿìêàõ. Ãîðèçîíòàëüíèé
âèì³ð ñèìâîë³çóº çëèòòÿ çíàíü, ïîðîäæåíèõ ôóíäà-
ìåíòàëüíèìè òà ïðèêëàäíèìè íàóêàìè äëÿ îáñëó-
ãîâóâàííÿ êë³í³÷íèõ íàóê, ³ íàâïàêè. Âåðòèêàëüíèé
âèì³ð â³äð³çíÿº êîìïëåêñíó ïåðñïåêòèâó íà îñíîâ³
³íòåãðàòèâíî¿ ìîäåë³ ôóíêö³îíóâàííÿ â³ä á³ëüø ôî-
êóñîâàíî¿ ïåðñïåêòèâè á³îìåäè÷íèõ àñïåêò³â
ôóíêö³îíóâàííÿ. ijàãîíàëüí³ ñòð³ëêè ³ëþñòðóþòü
ïîò³ê çíàíü ñòîñîâíî îáîõ âèì³ð³â. Àäàïòîâàíî ç 8, 19.
Ïîòî÷íèé ñòàí íàóêîâî-äîñë³äíî¿
ä³ÿëüíîñò³, ùî ïðåäñòàâëÿº ³íòåðåñ
äëÿ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
(ÔÐÌ) â ªâðîï³, ñïåöèô³êà òà ïðîáëåìè
ìàéáóòíüîãî
Íàóêîâî-äîñë³äíà ä³ÿëüí³ñòü, ùî ïðåäñòàâëÿº
³íòåðåñ äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³,
ïðåäñòàâëÿº á³ëüø øèðîêå êîëî, ùî îõîïëþº íàó-
êîâî-äîñë³äíó ä³ÿëüí³ñòü «Â» ô³çè÷í³é òà ðåàá³ë³-
òàö³éí³é ìåäèöèí³.
Íàóêîâ³ ìåäè÷í³ äîñë³äæåííÿ, ùî ïðåäñòàâëÿ-
þòü ³íòåðåñ äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëü-
174 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
íîñò³ àáî ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâîäÿòü äî
îáìåæåíü æèòòºä³ÿëüíîñò³, ï³äâèùóþòü íàóêîâ³
çíàííÿ, ÿê³ ïîë³ïøóþòü ÿê³ñòü æèòòÿ ëþäåé ç îá-
ìåæåííÿìè æèòòºä³ÿëüíîñò³ àáî ñòàíàìè çäîðî-
â’ÿ, ùî ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³.
Ïëàí ä³é Ñåêö³¿ ÔÐÌ ªâðîïåéñüêîãî ñîþçó
(ªÑ) ç íàóêè â ÔÐÌ
Ñåêö³ÿ ÔÐÌ ªÑÌÑ ðîçðîáèëà åôåêòèâíó ñòðà-
òåã³þ, ÿê ïóáë³êóâàòè äîêóìåíòè äîêàçîâî¿ ìåäè-
öèíè22,23, âêëþ÷àþ÷è “ô³çè÷íó òà ðåàá³ë³òàö³éíó
ìåäèöèíó” ó ñâî¿õ ìåäè÷íèõ ïðåäìåòíèõ ðóáðèêàõ
(MeSH).
²ñíóº ñèëüíà âîëÿ ºâðîïåéñüêèõ îðãàí³çàö³é
ÔÐÌ ùîäî ðîçâèòêó íàóêîâî-äîñë³äíî¿ ä³ÿëüíîñò³,
ÿêà ïðåäñòàâëÿº ³íòåðåñ äëÿ ÔÐÌ â ªâðîï³. Ìå-
òîþ ªâðîïåéñüêîãî òîâàðèñòâà ÔÐÌ (ªÒÔÐÌ),
Ñåêö³¿ òà Ðàäè ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷-
íèõ Ñïåö³àë³ñò³â (ªÑÌÑ) òà Àêàäå쳿 ðåàá³ë³òà-
ö³éíî¿ ìåäèöèíè (ªÀÐÌ) º:
– ï³äòðèìóâàòè ìåäèöèíó, ùî ´ðóíòóºòüñÿ íà
äîêàçàõ24, çà äîïîìîãîþ äîñë³äíèöüêèõ, îñâ³òí³õ
³ íàâ÷àëüíèõ ïðîãðàì, ùî çàëó÷àþòü ñòóäåíò³â-
ìåäèê³â, ðåçèäåíò³â ÔÐÌ òà ë³êàð³â ÔÐÌ;
– ñïðèÿòè, çì³öíþâàòè, îö³íþâàòè òà âèêîíóâàòè
âñ³ äîñë³äæåííÿ, çäàòí³ ïðîñóâàòè çíàííÿ, ÿê³
ñòîñóþòüñÿ ëþäåé ç õðîí³÷íèìè çàõâîðþâàííÿ-
ìè ÷è ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâîäÿòü äî îá-
ìåæåíü æèòòºä³ÿëüíîñò³, ³ ïðèíîñÿòü ñîö³àëüí³,
êóëüòóðí³ òà åêîíîì³÷í³ âèãîäè ñóñï³ëüñòâó,
– çàîõî÷óâàòè ñï³âïðàöþ ì³æ ôàõ³âöÿìè ð³çíèõ
äèñöèïë³í òà ðîçâèâàòè ì³æäèñöèïë³íàðí³ ïðî-
ãðàìè, ùî îá’ºäíóþòü äåê³ëüêà ìåäè÷íèõ
â³ää³ëåíü, à òàêîæ ³íø³ äîñë³äíèöüê³ óñòàíîâè
òà âèðîáíèê³â,
– ïîäîëàòè ïðîãàëèíè ì³æ ôóíäàìåíòàëüíèìè òà
ìåäè÷íèìè äîñë³äæåííÿìè òà ïåðåâåñòè ôóíäà-
ìåíòàëüí³ çíàííÿ äî êðàùî¿ êë³í³÷íî¿ ïðàêòèêè,
– ðîáèòè âíåñîê äî ïðîìîö³¿ òà çàñòîñóâàííÿ
ðåçóëüòàò³â äîñë³äæåíü â ñôåð³, ùî ñòîñóºòü-
ñÿ ëþäåé ç õðîí³÷íèìè çàõâîðþâàííÿìè ÷è ñòà-
íàìè çäîðîâ’ÿ, ùî ïðèçâîäÿòü äî îáìåæåíü
æèòòºä³ÿëüíîñò³,
– ðîçâèâàòè íàóêîâó ³íôîðìàö³þ ³ êîìóí³êàö³þ â
ñôåð³, ùî ñòîñóºòüñÿ ëþäåé ç õðîí³÷íèìè çà-
õâîðþâàííÿìè ÷è ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâî-
äÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³,
– áðàòè ó÷àñòü ó àíàë³ç³ ºâðîïåéñüêî¿ íàóêîâî¿
îð³ºíòàö³¿ òà ¿¿ ïîòåíö³àëó äî åâîëþö³¿ äëÿ ðîç-
ðîáêè ºâðîïåéñüêî¿ ïîë³òèêè äîñë³äæåíü â ñôåð³
îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³,
– ñïðèÿòè ó÷àñò³ ñòóäåíò³â òà ³íøèõ îñ³á ç îáìå-
æåííÿìè æèòòºä³ÿëüíîñò³, àáî ñòàíàìè çäî-
ðîâ’ÿ, ùî ïðèçâîäÿòü äî îáìåæåíü æèòòº-
ä³ÿëüíîñò³, ó âèù³é îñâ³ò³ òà äîñë³äíèöüê³é
ä³ÿëüíîñò³25.
¹2(2) *2018
 ÐÎÇÄ²Ë 10 – ÍÀÓÊÀ ÒÀ ÄÎÑ˲ÄÆÅÍÍß Ó ÔÐÌ: ÎÑÎÁËÈÂÎÑÒ² ÒÀ ÏÐÎÁËÅÌÈ
ªâðîïåéñüê³ ãðîìàäÿíè ïîçèòèâíî
ñòàâëÿòüñÿ äî á³îìåäè÷íèõ äîñë³äæåíü
Íåäàâíº îïèòóâàííÿ Ôðàíöóçüêîãî Íàö³îíàëü-
íîãî ²íñòèòóòó Çäîðîâ’ÿ òà Ìåäè÷íèõ Äîñë³äæåíü
(INSERM), ùî âêëþ÷àëî 4000 ãðîìàäÿí ªÑ, ïîêà-
çàëî, ùî äëÿ 82% ç íèõ ìåäè÷í³ äîñë³äæåííÿ çà-
áåçïå÷àòü êðàùå æèòòÿ ¿õ ä³òÿì. Öå ï³äêðåñëþº,
íàñê³ëüêè âàæëèâî ïîøèðþâàòè ³íôîðìàö³þ ïðî
äîñë³äæåííÿ ç ÔÐÌ äëÿ ãðîìàäÿí.
Äæåðåëà ô³íàíñóâàííÿ äîñë³äæåíü ó ÔÐÌ
º ÷èñëåííèìè ³ íåäîñòàòíüî â³äîì³
Íåçâàæàþ÷è íà äîâ³ðó ãðîìàäÿí ªÑ äî á³îìå-
äè÷íèõ äîñë³äæåíü, ñó÷àñí³ ìåòîäè ô³íàíñóâàííÿ
äîñë³äæåíü ìàþòü òåíäåíö³þ äî ïðèì³òèâ³çàö³¿
îõîðîíè çäîðîâ’ÿ òà ðåàá³ë³òàö³¿ îñ³á ç îáìåæåí-
íÿìè æèòòºä³ÿëüíîñò³ òà ñòàð³þ÷îãî íàñåëåííÿ.
˳êàð³ ÔÐÌ íàïîëÿãàþòü íà çì³í³26.
²íôîðìàö³ÿ ïðî ìîæëèâîñò³ ô³íàíñóâàííÿ ïîâèí-
íà áóòè ðîçðîáëåíîþ â ðàìêàõ ñïåö³àëüíîñò³ ÔÐÌ,
îñê³ëüêè â ªÑ òà çà ¿¿ ìåæàìè ³ñíóº áàãàòî ìîæ-
ëèâîñòåé.
Äîñë³äíèöüê³ ïðîãðàìè ªÑ, òàê³ ÿê «Horizon 2020»
(H2020)27, ïðîïîíóþòü ìîæëèâîñò³ ô³íàíñóâàííÿ
ï³ñëÿäîêòîðñüêèõ ïîñàä çàâäÿêè Marie Sklodowska
Curie Actions (âêëþ÷àþ÷è ñõåìè ñï³âô³íàíñóâàí-
íÿ)28. ²íôîðìàö³éíà ï³äòðèìêà íà H2020 äîñòóïíà
â ñàéò³ Euraxess29. Òåõí³÷íà ï³äòðèìêà ïðîïîíóºòü-
ñÿ ó êîæí³é ºâðîïåéñüê³é êðà¿í³ òà â äåÿêèõ óí³âåð-
ñèòåòàõ ÷åðåç íàö³îíàëüí³ êîíòàêòí³ ïóíêòè.
ªâðîïåéñüê³ òà ì³æíàðîäí³ áëàãîä³éí³ òà íåïðè-
áóòêîâ³ ôîíäè ÷àñòî ôîêóñóþòüñÿ íà ñïåöèô³÷íèõ
òåìàõ, âîíè íàäàþòü ô³íàíñîâó ï³äòðèìêó äîñë³ä-
æåííÿì. Íàïðèêëàä, ó ñôåð³ ñïèííîìîçêîâèõ
òðàâì öå ñòîñóºòüñÿ Wings for life30, ³íøèìè äîá-
ðå â³äîìèìè ïðèêëàäàìè º ôîíä Christopher òà
Dana Reeve31 òà ²íñòèòóòè Ìàêñà Ïëàíêà32.
Íàö³îíàëüí³ äîñë³äíèöüê³ àãåíö³¿ ç³áðàí³ äî «Sci-
ence Europe», ÿêà º àñîö³àö³ºþ European Research
Funding Organizations (RFO) 33 òà Research
Performing Organizations (RPO), ùî áàçóþòüñÿ â
Áðþññåë³.
Ìåäè÷í³ øêîëè òà óí³âåðñèòåòè ìàþòü ñïåö³àëüí³
áþäæåòè íà äîñë³äíèöüêó ä³ÿëüí³ñòü34. Ñòðóêòóðà
äîñë³äíèöüêîãî áþäæåòó óí³âåðñèòåòó äëÿ âñ³õ
êðà¿í ªÑ º äîñèòü íåçáàëàíñîâàíîþ, ç äåðæàâíèì
áþäæåòîì â ÿêîñò³ áàçîâîãî äæåðåëà ô³íàíñóâàí-
íÿ34. Çàêëàäè ÔÐÌ íà íàö³îíàëüíîìó àáî ì³æíàðîä-
íîìó ð³âí³ ï³äòðèìóþòü äîñë³äíèöüê³ ïðîãðàìè: ó
Ôðàíö³¿ – UGECAM35, ôðàíöóçüêà ìåðåæà çàêëàä³â
ÔÐÌ ïðè ³íñóëüò³, â ²òà볿 – Foundation Don Gnocchi36
äëÿ äîêàçîâî¿ ìåäèöèíè ³ Êîêðàí³âñüêîþ ðåàá³ë³òà-
ö³éíîþ ñôåðîþ, òà íà ñâ³òîâîìó ð³âí³ – Ramsay, äëÿ
ñïîðòèâíèõ çàõîä³â, ï³äïèñàëè ëèñòè ïðî íàì³ðè
ñï³âïðàö³ â äîñë³äí³é ä³ÿëüíîñò³ ç ªÒÔÐÌ.
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ó÷àñòü íåàêàäåì³÷íîãî ñåêòîðó â äîñë³äæåí-
íÿõ ªÑ (H2020) ðàõóºòüñÿ íåîäì³ííèì. Çàëó÷åí-
íÿ ó÷àñíèê³â ç ³íäóñòð³¿, çîêðåìà, ìàëèõ òà ñåðåäí³õ
ï³äïðèºìñòâ, ìຠâèð³øàëüíå çíà÷åííÿ äëÿ ìàêñè-
ì³çàö³¿ î÷³êóâàíîãî âïëèâó ä³é.
Åòè÷í³ ïèòàííÿ òà íàóêîâà/äîñë³äíèöüêà
àêòèâí³ñòü â ÔÐÌ
Çàõèñò ïðàâ ³ ã³äíîñò³ ëþäèíè â ñïåöèô³÷í³é
ñôåð³ á³îìåäè÷íèõ äîñë³äæåíü ñòຠá³ëüø ñóâîðèì,
í³æ öå áóëî â ìèíóëîìó. Äîñòóïí³ íàñòàíîâè ªÑ,
òàê³, ÿê Äîäàòêîâèé ïðîòîêîë äî Êîíâåíö³¿ ïðî
ïðàâà ëþäèíè òà á³îìåäèöèíè37, ÿêèé ñòîñóºòüñÿ
á³îìåäè÷íèõ äîñë³äæåíü òà çàõèñòó òâàðèí ó
äîñë³äæåííÿõ38,39.
Ôàõ³âö³ ÔÐÌ ïîâèíí³ çâåðòàòè óâàãó òà óíèêà-
òè êîíôë³êòó ³íòåðåñ³â ó ñâî¿é äîñë³äí³é ä³ÿëü-
íîñò³40,41. Íå-ïóáë³êàö³ÿ ðåçóëüòàò³â âèïðîáóâàíü
ë³êàðñüêèõ çàñîá³â òàêîæ âèêëèêຠåòè÷í³ ïðîáëå-
ìè â äîñë³äæåííÿõ 42. Çàâäàííÿì ªâðîïåéñüêî¿
ðàäè ç àêðåäèòàö³¿ áåçïåðåðâíî¿ ìåäè÷íî¿ îñâ³òè
ªÑÌÑ (EACCME) 43 º êîíòðîëü åòè÷íî¿ ÿêîñò³
êîíãðåñ³â ÔÐÌ.
Ïóáë³êàö³¿ çà òåìîþ «Ðåàá³ë³òàö³ÿ» ïîñò³éíî
çðîñòàþòü ïðîòÿãîì îñòàíí³õ äåêàä
ªâðîïà òà ÔÐÌ ìàëè ïðîâ³äíó ðîëü ó ö³é åâî-
ëþö³¿44. Ïóáë³êàö³¿ ç ÔÐÌ ïðîòÿãîì îñòàíí³õ 16
ðîê³â ç âèñîêèì ð³âíåì äîêàçîâîñò³ ïîêàçàëè
á³ëüø³ ìóëüòèïë³êàö³éí³ ôàêòîðè ïîð³âíÿëüíî ç
òèìè, ùî ìàþòü íèçüêèé ð³âåíü äîêàç³â45. Ïóáë³-
êàö³¿ ç ðåàá³ë³òàö³¿ âèäàþòüñÿ íå ò³ëüêè ôàõ³âöÿìè
ÔÐÌ, àëå é äîñë³äíèêàìè â ³íøèõ ñôåðàõ46.
Îáñÿã íàóêîâî-äîñë³äíî¿ ä³ÿëüíîñò³,
ïîâ’ÿçàíî¿ ç ÔÐÌ, º øèðîêèì
Îñíîâí³ íàïðÿìè íàóêîâî-äîñë³äíî¿ ä³ÿëüíîñò³,
ùî ïðåäñòàâëÿþòü ³íòåðåñ äëÿ ÔÐÌ, º ÷èñëåííè-
ìè. Âîíè ïðåäñòàâëÿþòü âñ³ êîìïîíåíòè òà äîìå-
íè/ðîçä³ëè ̳æíàðîäíî¿ êëàñèô³êàö³¿ õâîðîá òà
̳æíàðîäíî¿ êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ, îáìå-
æåíü æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ47.
Îñíîâí³ ñôåðè íàóêîâî-äîñë³äíî¿ ä³ÿëüíîñò³, ùî
ïðåäñòàâëÿþòü ³íòåðåñ äëÿ ÔÐÌ, ïîâ’ÿçàí³ ç îá-
ëàñòÿìè äîñë³äæåíü, îðãàí³çîâàíèõ íà ºâðîïåé-
ñüêîìó äîñë³äíèöüêîìó ð³âí³ â íàñòóïíèõ äèñöèï-
ë³íàõ48:
– íåéðîíàóêè, ç óñ³ìà íàóêîâèìè òà ìåäè÷íèìè
ñôåðàìè, ùî ñòîñóþòüñÿ öåíòðàëüíî¿ òà ïåðè-
ôåðè÷íî¿ íåðâîâî¿ ñèñòåìè: ¿¿ íîðìàëüíå òà ïà-
òîëîã³÷íå ôîðìóâàííÿ, ðîçâèòîê, ôóíêö³îíóâàí-
íÿ òà ñòàð³ííÿ49;
– ô³ç³îëîã³ÿ, ïàòîô³ç³îëîã³ÿ, ìåòàáîë³çì ³ õàð÷ó-
âàííÿ, ñåðöåâî-ñóäèííà ñèñòåìà, äèõàëüíà ñè-
ñòåìà, ê³ñòêè òà ñóãëîáè;
175
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
– ãðîìàäñüêå çäîðîâ’ÿ, âêëþ÷íî ç åï³äåì³îëî㳺þ,
á³îñòàòèñòèêîþ, åêîíîì³êîþ òà ñîö³îëî㳺þ, ùî
çàñòîñîâóþòüñÿ â ãàëóç³ îõîðîíè çäîðîâ’ÿ,
– òåõíîëî㳿 â ñôåð³ îõîðîíè çäîðîâ’ÿ, çîêðåìà
â³çóàë³çàö³ÿ, ðîçðîáêà ë³ê³â, á³îòåõíîëîã³ÿ, á³î-
³íæåíåð³ÿ, ³íòåðâåíö³éí³ ìåòîäè ìåäè÷íî¿ ä³àã-
íîñòèêè òà ë³êóâàííÿ;
– êë³òèííà á³îëîã³ÿ, ðîçâèòîê ³ åâîëþö³ÿ;
– ãåíåòèêà, ãåíîì³êà òà á³î³íôîðìàòèêà.
Ìîäàëüíîñò³ íàóêîâî¿ òà äîñë³äíî¿
ä³ÿëüíîñò³, ùî ïðåäñòàâëÿþòü ³íòåðåñ
äëÿ ÔÐÌ, º ÷èñëåííèìè
Íàóêîâ³ äîñë³äæåííÿ, ùî ïðåäñòàâëÿþòü ³íòå-
ðåñ äëÿ ÔÐÌ, º â îñíîâíîìó â ñôåð³ á³îìåäè÷íèõ
äîñë³äæåíü, ÿêà º øèðîêîþ íàóêîâîþ ãàëóççþ, ùî
âêëþ÷ຠâ ñåáå äîñë³äæåííÿ á³îëîã³÷íîãî ïðîöå-
ñó, ïðè÷èí çàõâîðþâàíü, ¿õ ìåäè÷íó ä³àãíîñòèêó,
îö³íêó ¿õ íàñë³äê³â äëÿ ôóíêö³îíóâàííÿ, îáìåæåíü
æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ, íà ³íäèâ³äóàëüíîìó
òà ñîö³àëüíîìó ð³âíÿõ. Ó ö³é ñôåð³ áåðå ó÷àñòü The
Alliance for Biomedical Research in Europe50.
Á³îìåäè÷í³ äîñë³äæåííÿ ç ÔÐÌ ïåðåâàæíî
ïðåäñòàâëåí³ êë³í³÷íèìè äîñë³äæåííÿìè òà
êë³í³÷íèìè âèïðîáóâàííÿìè.
Äîñë³äíèêè ÔÐÌ ÷àñò³øå, í³æ ó ìèíóëîìó, çà-
ëó÷åí³ äî:
– ì³æäèñöèïë³íàðíèõ äîñë³äíèöüêèõ ïðîãðàì â
êîìàíäàõ, ùî âêëþ÷àþòü ³íø³ äèñöèïë³íè àáî
ñïåö³àë³çîâàí³ çíàííÿ. Human Brain Project º
ì³æäèñöèïë³íàðíîþ ïðîãðàìîþ, ÿêà ñï³âô³íàí-
ñóºòüñÿ ªÑ 51;
– ïðèêëàäíèõ ïðîãðàì äîñë³äæåíü, ùî ñïðÿìîâàí³
íà êîíêðåòí³ ö³ë³ òà â³äêðèòòÿ, òàê³, ÿê ðîçðîá-
êà íîâîãî ë³êàðñüêîãî çàñîáó, íîâîãî ìåäè÷íî-
ãî ïðèëàäó, àáî íîâî¿ ïðîöåäóðè ðåàá³ë³òàö³¿.
Âîíè âèêîðèñòîâóþòü ³ñíóþ÷³ çíàííÿ (îòðèìàí³
ç ôóíäàìåíòàëüíèõ äîñë³äæåíü) òà ìåòîäè÷íî
ðîçøèðþþòü ö³ çíàííÿ äëÿ âèð³øåííÿ ñïåöè-
ô³÷íèõ ðåàá³ë³òàö³éíèõ ïðîáëåì46;
– äîêë³í³÷íèõ âèïðîáóâàíü, ùî âêëþ÷àþòü åêñïå-
ðèìåíò íà êë³òèíàõ òà òâàðèííèõ ìîäåëÿõ52;
– òðàíñëÿö³éíèõ äîñë³äæåíü, äîñë³äæåíü òà ðîç-
ðîáîê, â³ä ëàáîðàòî𳿠äî ë³æêà ³ äîì³âêè ïàö³ºí-
òà, ÿê³ º ìåòîþ European Advanced Translational
Research Infrastructure in Medicine 53,54 , àëå
íàâ³òü íàéá³ëüø ïåðñïåêòèâí³ äàí³, îäåðæàí³ ó
ôóíäàìåíòàëüíèõ äîñë³äæåííÿõ, ïîòðåáóþòü
áàãàòî ÷àñó äëÿ âïðîâàäæåííÿ ¿õ äî êë³í³÷íèõ
åêñïåðèìåíò³â òà ïðèéíÿòòÿ ¿õ äî êë³í³÷íî¿ ïðàê-
òèêè º ð³äêèì55;
– äîñë³äæåíü âïðîâàäæåííÿ (ÄÂ), îö³íêè ðåàá³-
ë³òàö³éíèõ âòðó÷àíü â îõîðîí³ çäîðîâ’ÿ â óìî-
âàõ «ðåàëüíîãî ñâ³òó»56;
– äîñë³äæåíü ðîáîòîòåõí³êè òà ïðèñòðî¿â, ³íôîð-
ìàö³éíî-êîìóí³êàö³éíèõ òåõíîëîã³é (²ÊÒ), ÿê³
176 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
çãàäóþòüñÿ ó áàãàòüîõ äîñë³äíèõ ïðîãðàìàõ
ªÑ «IÊT H2020» äëÿ âèð³øåííÿ ñîö³àëüíèõ ïðî-
áëåì;
– ïðîãðàì ôóíäàìåíòàëüíèõ äîñë³äæåíü, â ÿêèõ
ë³êàð³ ÔÐÌ ³íîä³ áåðóòü ó÷àñòü ó ïðîöåñ³ ìà-
ã³ñòåðñüêîãî, äèñåðòàö³éíîãî àáî ï³ñëÿ-äîê-
òîðñüêîãî íàâ÷àííÿ.
Çàêëàäè íàóêîâî-äîñë³äíî¿ ä³ÿëüíîñò³
â ÔÐÌ º ÷èñëåííèìè
×èñëî àêàäåì³÷íèõ ïðîôåñîð³â ó ÔÐÌ çðîñòàº
â äåÿêèõ êðà¿íàõ ªÑ, ùî ïðèçâîäèòü äî ðîçâèòêó
êë³í³÷íèõ äîñë³äæåíü â ¿õ êîìàíäàõ.
Çá³ëüøóºòüñÿ ÷èñëî çàêëàä³â ÔÐÌ ç êë³í³÷íîþ
äîñë³äíèöüêîþ ä³ÿëüí³ñòþ, äåÿê³ ç ÿêèõ ìàþòü
óãîäè ç óí³âåðñèòåòàìè òà/àáî ªâðîïåéñüêèìè
Îðãàíàìè ÔÐÌ, òàêèìè, ÿê ªâðîïåéñüêå Òîâàðè-
ñòâî ÔÐÌ (Foundation Don Gnocchi36, UGECAM35,
Ramsay Health Care57).
Äîñë³äíèöüê³ êîìàíäè, êàôåäðè, ëàáîðàòî𳿠òà
³íñòèòóòè ðîçâèâàþòü ì³æäèñöèïë³íàðí³ íàóêîâ³
äîñë³äæåííÿ, â³ä ôóíäàìåíòàëüíèõ äî ïðèêëàäíèõ
äîñë³äæåíü â îäí³é àáî äåê³ëüêîõ ñïåöèô³÷íèõ
ñôåðàõ58. ¯õ î÷îëþþòü â÷åí³ òà/àáî ôàõ³âö³ ÔÐÌ.
Âîíè ÷àñòî º ÷àñòèíîþ íàö³îíàëüíèõ àáî ì³æíà-
ðîäíèõ ìåðåæ, ñôîêóñîâàíèõ íà äàí³é ñôåð³.
Åëåêòðîííà ï³äòðèìêà äëÿ êîìóí³êàö³¿ òà ³íôîð-
ìàö³¿ ç íàóêîâî-äîñë³äíî¿ ä³ÿëüíîñò³ ç ÔÐÌ ïåðå-
âàæíî áàçóºòüñÿ íà âåá-ñàéòàõ ºâðîïåéñüêèõ
îðãàí³çàö³é ÔÐÌ.
ªâðîïåéñüêà Àêàäåì³ÿ Ðåàá³ë³òàö³éíî¿ Ìåäèöè-
íè 59, Ñåêö³ÿ òà Ðàäà ÔÐÌ ªÑÌÑ 60 òà ªÒÔÐÌ
ïîøèðþþòü íàóêîâó ³íôîðìàö³þ ïî âñüîìó ñâ³òîâ³.
²íø³ íàóêîâ³ âåá-ñàéòè äîñòóïí³ â ïåâíèõ ñôåðàõ,
íàïðèêëàä, äëÿ ³íñóëüòó – “äîêàçîâèé îãëÿä ðåàá³-
ë³òàö³¿ ïðè ³íñóëüò³”61.
Êîíãðåñè ªÒÔÐÌ òà ºâðîïåéñüê³ / ºâðî-
ñåðåäçåìíîìîðñüê³ øêîëè ç ÔÐÌ º óñï³øíèìè
˳êàð³ ÔÐÌ áåðóòü ó÷àñòü ÿê ó êîíãðåñàõ
ÔÐÌ, òàê ³ â êîíãðåñàõ, ñôîêóñîâàíèõ íà ïåâí³é òå-
ìàòèö³. Òåìàìè ìîæóòü áóòè òàê³ ïàòîëî㳿, ÿê
³íñóëüò, ïîøêîäæåííÿ ñïèííîãî ìîçêó, ôóíêö³î-
íàëüí³ ðîçëàäè, òàê³ ÿê, íàïðèêëàä, êîâòàííÿ,
ïñèõ³÷í³ ðîçëàäè; âòðó÷àííÿ â îõîðîí³ çäîðîâ’ÿ,
òàê³, ÿê óëüòðàçâóêîâà ä³àãíîñòèêà, ³í’ºêö³¿ â ñóã-
ëîáè òîùî.
Êîíãðåñè ªâðîïåéñüêîãî òîâàðèñòâà ÔÐÌ ïðî-
âîäÿòüñÿ êîæí³ äâà ðîêè. Âîíè ç³áðàëè äî 2400
ó÷àñíèê³â. Ó öèõ êîíãðåñàõ áåðóòü ó÷àñòü îñíîâí³
ºâðîïåéñüê³ îðãàí³çàö³¿ ÔÐÌ: Ñåêö³ÿ òà Ðàäà ÔÐÌ
ªÑÌÑ òà ªâðîïåéñüêà Àêàäåì³ÿ Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè. Îñíîâíèìè òåìàìè öèõ êîíãðåñ³â º
äîñë³äæåííÿ, îñâ³òà, ïðîôåñ³éíà ïðàêòèêà, ñôåðà
êîìïåòåíòíîñòåé òà åòèêà. Ðîçãëÿäàþòüñÿ âñ³
îáëàñò³ ÔÐÌ.
¹2(2) *2018
 ÐÎÇÄ²Ë 10 – ÍÀÓÊÀ ÒÀ ÄÎÑ˲ÄÆÅÍÍß Ó ÔÐÌ: ÎÑÎÁËÈÂÎÑÒ² ÒÀ ÏÐÎÁËÅÌÈ
ϳä ÷àñ êîíãðåñó ªÒÔÐÌ â 2016 ðîö³ áóëî ïðî-
âåäåíî äâà íîâèõ çàõîäè: «Äåííà ëàáîðàòîðíà ñå-
ñ³ÿ» ³ «Ìî¿ òåçè ïðî ðåàá³ë³òàö³þ çà 180 ñåêóíä»
(MRT180). Âîíè â³äáóäóòüñÿ çíîâó íà ÷åðãîâî-
ìó êîíãðåñ³ â ³ëüíþñ³ â òðàâí³ 2018 ðîêó. Ïå-
ðåë³ê ì³æíàðîäíèõ òà ªâðîïåéñüêèõ íàö³îíàëüíèõ
êîíãðåñ³â ç ÔÐÌ º íà ñàéò³ ªÒÔÐÌ ó êàëåíäàð³
ïîä³é62.
Ùîð³÷íî ïðîâîäÿòüñÿ òðè ì³æíàðîäí³ øêîëè ç
ÔÐÌ. Âîíè ïîøèðþþòü çíàííÿ, çàñíîâàí³ íà äî-
êàçàõ, òà ïðåäñòàâëÿþòü îñòàíí³ äîñë³äæåííÿ äëÿ
ðåçèäåíò³â ÔÐÌ (Euro Mediterranean Rehabilitation
Summer School Haim Ring ó ѳðàêóçàõ, ²òàë³ÿ,
Intensive Teaching Programme Cofemer Ajmer
Sofmer òà European School Marseille ó Ôðàíö³¿ ç
ðóõîâèõ îáìåæåíü æèòòºä³ÿëüíîñò³). Íîâà ºâðî-
ïåéñüêà øêîëà äëÿ ðåçèäåíò³â ÔÐÌ áóäå äîñòóï-
íîþ ó ³ëüíþñ³ ó 2018 ðîö³.
ªâðîïåéñüê³ òà ì³æíàðîäí³ êîíãðåñè, ïðèñâÿ÷åí³
ñïåöèô³÷íèì òåìàì, òàêèì ÿê á³ëü, ëþäè ïîõèëî-
ãî â³êó, ³íñóëüò, ñïèííîìîçêîâà òðàâìà, åëåêòðî-
íåéðîì³îãðàô³ÿ òîùî, çàïðîøóþòü ë³êàð³â ÔÐÌ òà
âñ³õ ôàõ³âö³â, çàö³êàâëåíèõ ó ö³é ñôåð³. ªÒÔÐÌ
ñòâîðèëî ñïåö³àë³çîâàí³ íàóêîâ³ êîì³òåòè63, ÿê³ º
çâ’ÿçêîì ì³æ ªÒÔÐÌ, íàóêîâèìè òîâàðèñòâàìè
òà âñ³ìà ôàõ³âöÿìè, ñôîêóñîâàíèìè íà òåì³, ç³
ñïåö³àë³çîâàíèìè êîíãðåñàìè ³ íàóêîâèìè æóðíà-
ëàìè.
Íàóêîâ³ æóðíàëè ç ÔÐÌ º äóæå àêòèâíèìè
Ïîä³áíî äî óñíèõ íàóêîâèõ âèñòóï³â ïðîòÿãîì
êîíãðåñ³â, ïèñüìîâà íàóêîâà êîìóí³êàö³ÿ â³ä ë³êàð³â
ÔÐÌ ìîæå áóòè ïîäàíîþ àáî äî æóðíàë³â ÔÐÌ,
àáî äî ³íøèõ íàóêîâèõ æóðíàë³â, ùî ñïåö³àë³çóþòü-
ñÿ íà ïåâí³é òåì³. Ïîÿâà òà ðîçâèòîê â³äêðèòîãî
äîñòóïó áóëè ³ çàëèøàþòüñÿ âåëèêèì âèêëèêîì ÿê
äëÿ àâòîð³â, òàê ³ äëÿ ÷èòà÷³â. Íå çàâæäè ëåãêî
çàâàíòàæèòè ïîâíîòåêñòîâó âåðñ³þ.
European Journal of PRM º îô³ö³éíèì æóðíàëîì
ªÒÔÐÌ òà Ñåêö³¿ ÔÐÌ ªÑÌÑ64.
Journal of Rehabilitation Medicine º îô³ö³éíèì
æóðíàëîì ªâðîïåéñüêî¿ Àêàäå쳿 Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè òà ªâðîïåéñüêî¿ Ðàäè ÔÐÌ ªÑÌÑ65.
Ïåðåë³ê ³íøèõ ºâðîïåéñüêèõ æóðíàë³â ç ÔÐÌ
íàäàíèé â ïóáë³êàö³¿66.
Êîêðàí³âñüêà ðåàá³ë³òàö³éíà ñôåðà º øàíñîì
äëÿ ìàéáóòíüîãî ðåàá³ë³òàö³¿
Îãëÿä íàóêîâî¿ ë³òåðàòóðè ìຠñïðàâó ç âòîðèí-
íèìè äæåðåëàìè, îïóáë³êîâàíèìè â àêàäåì³÷íèõ,
ðåöåíçîâàíèõ æóðíàëàõ, òà ñë³äóº ìåòîäîëî㳿 äëÿ
àíàë³çó äîñòóïíèõ äàíèõ (êëþ÷îâ³ ñëîâà, ìåäè÷í³
ïðåäìåòí³ ðóáðèêè, ïîøóêîâ³ ñèñòåìè, òàê³, ÿê
PubMed). Îãëÿä íàóêîâî¿ ë³òåðàòóðè çàáåçïå÷óº
ïîòî÷íèé ñòàí ìåäè÷íèõ íàóêîâèõ çíàíü â äàí³é
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ñôåð³. Íàïðèêëàä, äëÿ ³íñóëüòó öå º Evidence-based
review on stroke rehabilitation61.
Ïî÷èíàþ÷è ç Êîì³òåòó äîêàçîâî¿ ìåäèöèíè
ªÒÔÐÌ 63 ï³ä êåð³âíèöòâîì ïðîôåñîðà Stefano
Negrini òà éîãî êîëåã (Carlotte Kiekens, Elena Ilieva
òà Frane Grubisic), ºâðîïåéñüê³ îðãàí³çàö³¿ ÔÐÌ òà
³íø³ ì³æíàðîäí³ îðãàí³çàö³¿ ÔÐÌ áóëè çàïðîøåí³
Cochrane äî íîâî¿ «Êîêðàí³âñüêî¿ ðåàá³ë³òàö³éíî¿
ñôåðè»67, ùî ´ðóíòóºòüñÿ íà îñíîâ³ ñôåðè êîìïå-
òåíòíîñòåé ÔÐÌ.
Êîêðàí³âñüêà ðåàá³ë³òàö³éíà ñôåðà ìຠçà ìåòó
çàáåçïå÷åííÿ ìîæëèâîñò³ çàñòîñóâàííÿ êë³í³÷íî¿
äîêàçîâî¿ ïðàêòèêè âñ³ìà ôàõ³âöÿìè ðåàá³ë³òàö³¿,
ïîºäíóþ÷è êðàù³ íàÿâí³ äîêàçè, ç³áðàí³ âèñîêî-
ÿê³ñíèìè Êîêðàí³âñüêèìè ñèñòåìàòè÷íèìè îãëÿ-
äàìè, ç ¿õ âëàñíèì êë³í³÷íèì äîñâ³äîì ³ ö³ííîñòÿ-
ìè ïàö³ºíò³â. Íàøå áà÷åííÿ – öå ñâ³ò, íà ÿêîìó
îñîáè, êîòð³ ïðèéìàþòü ð³øåííÿ, çìîæóòü ïðèéìà-
òè ö³ ð³øåííÿ â³äïîâ³äíî äî êðàùèõ òà íàéâ³äïîâ³ä-
í³øèõ äîêàç³â ó ö³é ñïåöèô³÷í³é ñôåð³. Êîêðàí³âñüêà
ðåàá³ë³òàö³éíà ñôåðà áàæຠïîë³ïøèòè ìåòîäè
ñèíòåçó äîêàç³â, çðîáèòè ¿õ óçãîäæåíèìè ç ïîòðå-
áàìè îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³, àáî çàç-
íàþ÷èõ îáìåæåíü æèòòºä³ÿëüíîñò³ òà â ïîâñÿê-
äåíí³é êë³í³÷í³é ðåàá³ë³òàö³éí³é ïðàêòèö³.
Ïðîáëåìè ìàéáóòíüîãî
Îñíîâí³ âèêëèêè, ÿê³ âïëèâàþòü íà äîñë³äíèöüêó
ä³ÿëüí³ñòü ó ô³çè÷í³é òà ðåàá³ë³òàö³éí³é ìåäèöèí³
– åòè÷íèé, ç ïðàâàìè Îðãàí³çàö³¿ Îá’ºäíàíèõ
Íàö³é äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³68 íà ð³âíèé äîñòóï äî ìåäèöèíè òà ðåàá³-
ë³òàö³¿, äî ÿêîñò³ æèòòÿ â ñóñï³ëüñòâ³;
– ãðîìàäñüêîãî çäîðîâ’ÿ, ç äåìîãðàô³ºþ õðî-
í³÷íèõ çàõâîðþâàíü, ðîçâèòêîì ïîðóøåíü, ïî-
â’ÿçàíèõ ç â³êîì43, ðàçîì ç ñîö³àëüíèì âïëèâîì
äîñë³äæåíü69;
– íàóêîâèé, ç ðîçâèòêîì ìåäè÷íèõ íàóêîâèõ çíàíü
ó âñ³õ îáëàñòÿõ69 ;
– òåõíîëîã³÷íèé, ÿêèé äåìîíñòðóºòüñÿ çðîñòàí-
íÿì âèêîðèñòàííÿ â³çóàë³çàö³éíèõ òà äîñë³ä-
íèöüêèõ ëàáîðàòîð³é ç ì³æäèñöèïë³íàðíîþ
ä³ÿëüí³ñòþ, ùî âêëþ÷ຠêë³í³öèñò³â70.
Òàêîæ ç ðîçâèòêîì åëåêòðîííî¿ ìåäèöèíè (áàçè
äàíèõ, ïîøóêîâ³ ñèñòåìè, åëåêòðîíí³ êíèãè) òà ðî-
áîòîòåõí³êè71,72.
– åêîíîì³÷íèé, ³ç çá³ëüøåííÿì âèòðàò íà îõîðîíó
çäîðîâ’ÿ íà äåðæàâíîìó ð³âí³ òà âèòðàòàìè íà
äîñë³äæåííÿ. Ô³íàíñóâàííÿ äîñë³äæåíü â ªÑ íå
º îäíèì ç íàéâèùèõ â ñâ³ò³, âîíî â³äð³çíÿºòüñÿ â³ä
îäí³º¿ êðà¿íè-÷ëåíà ªÑ äî ³íøî¿. Ó 2020 ðîö³ 3%
âàëîâîãî âíóòð³øíüîãî ïðîäóêòó ªÑ (ÂÂÏ) ñë³ä
³íâåñòóâàòè â äîñë³äæåííÿ òà ðîçðîáêè. Çäîðî-
â’ÿ òà ñòàð³ííÿ º îäíèìè ç îñíîâíèõ òåì
äîñë³äæåíü äëÿ ïðîãðàì ªÑ (Europa EU).
177
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ÔÐÌ â ªâðîï³ ãîòîâà çá³ëüøèòè ê³ëüê³ñòü
äîñë³äíèê³â òà ï³äâèùèòè ÿê³ñòü äîñë³äæåíü
Îñâ³òà äëÿ äîñë³äæåíü áóäå êëþ÷îâèì ïèòàí-
íÿì ïðîòÿãîì óñüîãî ìåäè÷íîãî íàâ÷àííÿ, äëÿ
ñòóäåíò³â äîäèïëîìíîãî ð³âíÿ, ï³ñëÿäèïëîìíèõ
ðåçèäåíò³â ÔÐÌ, ùî ìàþòü äîñòóï äî ìàã³ñòåð-
ñüêèõ òà äèñåðòàö³éíèõ ïðîãðàì, ïîñòäîêòîðñüêèõ
ïðîãðàì.
Äîäèïëîìí³ ïðîãðàìè â ìåäè÷íèõ øêîëàõ ïî-
âèíí³ âêëþ÷àòè àíàë³òè÷íå ÷èòàííÿ73 ³ á³îñòàòè-
ñòèêó. ϳñëÿäèïëîìí³ ïðîãðàìè íà ôàêóëüòåòàõ
ìåäèöèíè ïîâèíí³ ï³äòðèìóâàòè ðîçâèòîê íàóêîâî-
ãî ìèñëåííÿ â æóðíàëüíèõ êëóáàõ74, ìàã³ñòåðñüêèõ
ïðîãðàìàõ ç ïî÷àòêîì äîñë³äæåíü ïðîòÿãîì ïåð-
øîãî ðîêó íàâ÷àííÿ. Òåìè, ÿê³ ÷àñòî çóñòð³÷àþòü-
ñÿ: ñèñòåìàòè÷í³ îãëÿäè, ïîøóêîâ³ áàçè äàíèõ
ìåäè÷íî¿ ë³òåðàòóðè, óïðàâë³ííÿ á³áë³îãðàô³ºþ,
ìåòîäè òåðàïåâòè÷íî¿ îö³íêè, ïðèíöèïè åï³äåì³î-
ëî㳿, ïåðåäîâà á³îñòàòèñòèêà, êðèòè÷íå ìèñëåííÿ,
íàâ÷àííÿ â ëàáîðàòî𳿠òîùî.
 äàíèé ÷àñ äîñòóïí³ ñòàòò³, íàâ÷àëüí³ ïðîãðà-
ìè äëÿ íàóêîâîãî óñíîãî òà ïèñüìîâîãî ñï³ëêóâàí-
íÿ, äëÿ àêàäåì³÷íèõ çóñòð³÷åé, ì³æäèñöèïë³íàðíî¿
ñï³âïðàö³, àáî äëÿ ñóñï³ëüíî-îð³ºíòîâàíîãî ñï³ëêó-
âàííÿ 75-77.
ϳä ÷àñ êîíãðåñó ªÒÔÐÌ áóëî îðãàí³çîâàíî
ïðåçåíòàö³¿ ïðîòÿãîì òðüîõ õâèëèí äîñë³äíèõ ðîá³ò
äèñåðòàíò³â, òàê çâàíà «Ìî¿ òåçè ç ðåàá³ë³òàö³¿ çà
180 ñåêóíä», ùî º ñïîñîáîì ïðåäñòàâèòè ïðîñòè-
ìè ñëîâàìè ïðîåêò äîñë³äæåííÿ â ðåàá³ë³òàö³¿ çà
êîðîòêèé ÷àñ, ó âèãëÿä³ òðèõâèëèííèõ òåç78.
Øêîëà Ðàäè / ªÒÔÐÌ: ï³ä ÷àñ íàñòóïíîãî êîí-
ãðåñó â ³ëüíþñ³ âïåðøå áóäå îðãàí³çîâàíà øêî-
ëà äëÿ ðåçèäåíò³â ÔÐÌ, ÿêà áóäå îõîïëþâàòè
âåñü íàâ÷àëüíèé ïëàí ñïåö³àëüíîñò³. Áóäå âèêî-
ðèñòàíèé äîñâ³ä ñïåö³àëüíèõ ñåñ³é òðüîõ øê³ë äëÿ
ºâðîïåéñüêèõ ðåçèäåíò³â ÔÐÌ, ÿê³ îðãàí³çîâóþòü-
ñÿ ùîðîêó, Euro Mediterranean Rehabilitation
Summer School â ѳðàêóçàõ, Intensive teaching
programme COFEMER, SOFMER, AJMER (ï³ä
÷àñ ôðàíöóçüêèõ êîíãðåñ³â SOFMER) ³ European
School Marseille ç ðóõîâèõ îáìåæåíü æèòòºä³ÿëü-
íîñò³. Óðîêè ç îñíîâíèõ òåì íàøî¿ ñïåö³àëüíîñò³
áóäóòü ïðîâîäèòèñÿ åêñïåðòàìè â ö³é ãàëóç³.
ªÒÔÐÌ çàîõî÷óº äîñòóï ìàã³ñòð³â ÔÐÌ, äè-
ñåðòàíò³â ³ ôàõ³âö³â ïîñòäîêòîðñüêîãî ð³âíÿ äî
äîñë³äíèöüêèõ ïðîãðàì ªÑ, òàêèõ ÿê H2020. Äè-
ñåðòàíòè ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³ ìîæóòü
áóòè ï³äòðèìàí³ ñïåö³àëüíèì ô³íàíñóâàííÿì79.
ªâðîïåéñüê³ îðãàí³çàö³¿ ÔÐÌ â äàíèé ÷àñ çà-
ëó÷åí³ ³ áàæàþòü çðîáèòè á³ëüøå äëÿ ðîçâèòêó
íàóêîâî-äîñë³äíî¿ ä³ÿëüíîñò³, ùî ïðåäñòàâëÿº
³íòåðåñ äëÿ îñ³á ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³.
Âîíè ïåðåêîíàí³, ùî ìàéáóòíº ÔÐÌ – öå äîñë³ä-
æåííÿ!
178 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Âàæëèâ³ñòü ðåàá³ë³òàö³éíèõ äîñë³äæåíü
ó âñòàíîâëåíí³ ïîòðåá òà ö³ííîñò³
ÿê ñó÷àñíèõ, òàê ³ íîâèõ ï³äõîä³â
äî ðåàá³ë³òàö³¿
ÔÐÌ ïîâí³ñòþ ñõâàëèëà ïðèíöèïè äîêàçîâî¿
ìåäèöèíè, òà äîñë³äæåííÿ â ÔÐÌ çðîáèëè çíà÷í³é
ïðîãðåñ ïðîòÿãîì îñòàíí³õ òðüîõ äåñÿòèë³òü. Ó òîé
÷àñ, ÿê ô³ç³îëîã³÷í³ ìåõàí³çìè 䳿 ô³çè÷íèõ ôóíê-
ö³îíàëüíèõ ìîäàëüíîñòåé òðàäèö³éíî áóëè öåíòðîì
íàóêîâîãî ³íòåðåñó ïðîòÿãîì îñòàíí³õ äåñÿòèë³òü
ÕÕ ñòîë³òòÿ, çá³ëüøèëàñÿ ê³ëüê³ñòü ïðîñïåêòèâíèõ
âèïðîáóâàíü, â ÿêèõ îö³íþâàëàñü êë³í³÷íà åôåê-
òèâí³ñòü ðåàá³ë³òàö³¿ ïðè áàãàòüîõ çàõâîðþâàííÿõ,
òàêèõ ÿê ïîïåðåêîâèé á³ëü, ³íñóëüò, òðàâìè ãîëîâ-
íîãî ³ ñïèííîãî ìîçêó78-80, ðåâìàòî¿äíèé àðòðèò,
ñåðöåâî-ñóäèíí³, ëåãåíåâ³ òà ìåòàáîë³÷í³ ïîðóøåí-
íÿ. Äëÿ á³ëüøîñò³ ñòàí³â äîñòóïíèìè º ìåòà-àíàë³-
çè òà (ì³æ)íàö³îíàëüí³ íàñòàíîâè, êë³í³÷í³ ïðîòîêî-
ëè, ÿê³ íàäàþòü ð³âí³ äîêàçîâîñò³ îêðåìèõ âòðó÷àíü.
Äîðå÷í³ñòü äîñë³äæåíü
Ñïåö³àëüí³ñòü ñïðÿìîâàíà íà ñïðèÿííÿ ï³äâèùå-
íîìó ³íòåðåñó òà çàëó÷åííÿ äî äîñë³äæåíü ç ðåà-
á³ë³òàö³¿. Öå ïðèçâåëî äî çá³ëüøåííÿ ê³ëüêîñò³ ïóá-
ë³êàö³é â ì³æíàðîäíèõ íàóêîâèõ æóðíàëàõ ç
âèñîêèì ð³âíåì âïëèâó. ¯¿ áà÷åííÿ ïîëÿãຠâ òîìó,
ùî äîñë³äæåííÿ º íåîáõ³äíèìè äëÿ ðîçóì³ííÿ ôóí-
äàìåíòàëüíèõ ïðîöåñ³â ðåàá³ë³òàö³¿, çîêðåìà, ÿê
ëþäè íàáóâàþòü íîâèõ íàâè÷îê òà, ÿê òêàíèíè ò³ëà
(íàïð. ì’ÿçè, àáî íåéðîíí³ øëÿõè â öåíòðàëüíî¿
íåðâîâ³é ñèñòåì³) ìîæóòü â³äíîâèòèñÿ àáî àäàï-
òóâàòèñÿ äî âïëèâó íàñë³äê³â òðàâìè àáî õâîðîáè.
Äîñë³äæåííÿ ìîæóòü òàêîæ âèçíà÷àòè çàõâîðþ-
âàí³ñòü òà ïîøèðåí³ñòü îáìåæåíü æèòòºä³ÿëüíîñò³
òà âèçíà÷àòè äåòåðì³íàíòè ÿê â³äíîâëåííÿ, òàê ³
çäàòíîñò³ äî çì³í, çäîáóòòÿ íîâèõ íàâè÷îê ³ ðåà-
ãóâàííÿ íà ðåàá³ë³òàö³þ.
Íîâ³ òåõíîëî㳿 âèíèêàþòü òà ìàþòü áóòè àäàï-
òîâàíèìè äëÿ âèêîðèñòàííÿ îñîáàìè ç îáìåæåí-
íÿìè æèòòºä³ÿëüíîñò³. Ðåàá³ë³òàö³éí³ òåõíîëî㳿 º
îäí³ºþ ç íàéâàæëèâ³øèõ ³ ïåðñïåêòèâíèõ ñôåð äîñ-
ë³äæåíü ñüîãîäí³ ³ â ìàéáóòíüîìó. Òêàíèííà ³íæå-
íåð³ÿ òà ³íø³ ñó÷àñí³ òåõíîëî㳿 ñïðèÿþòü ö³é ñôåð³.
Âèòðàòè íà îõîðîíó çäîðîâ’ÿ ³ ðåàá³ë³òàö³éí³ ïîñëó-
ãè áóäóòü çá³ëüøóâàòèñÿ, òà ïîë³òèêè áóäóòü çìó-
øóâàòè íàäàâà÷³â äîïîìîãè â îõîðîí³ çäîðîâ’ÿ
îáìåæèòè ñâî¿ âèòðàòè ³ ïîêàçàòè, ùî âîíè åôåê-
òèâíî îðãàí³çîâóþòü öþ äîïîìîãó. Ñïåö³àëüí³ñòü
ÔÐÌ º íàä³éíèì ïàðòíåðîì ó äèñêóñ³¿ ç ïàö³ºíòà-
ìè, ïîë³òèêàìè, ì³í³ñòåðñòâàìè îõîðîíè çäîðîâ’ÿ
òà ñòðàõîâèìè êîìïàí³ÿìè, îñê³ëüêè âîíà ìàº
çäàòí³ñòü ïóáë³÷íî ´ðóíòóâàòè àðãóìåíòè íà
äîñòîâ³ðíèõ äîêàçàõ, ÿê³ ìîæóòü çàáåçïå÷èòè
ò³ëüêè äîñë³äæåííÿ.
¹2(2) *2018
 ÐÎÇÄ²Ë 10 – ÍÀÓÊÀ ÒÀ ÄÎÑ˲ÄÆÅÍÍß Ó ÔÐÌ: ÎÑÎÁËÈÂÎÑÒ² ÒÀ ÏÐÎÁËÅÌÈ
Ìåòîäîëîã³ÿ äîñë³äæåíü â ô³çè÷í³é
òà ðåàá³ë³òàö³éí³é ìåäèöèí³: ïîäîëàííÿ
ðîçðèâó ì³æ á³îëî㳺þ òà ïîâåä³íêîþ.
Á³îìåäèöèíà òà ô³çè÷íà òà ðåàá³ë³òàö³éíà
ìåäèöèíà: íàóêà øèðøà, í³æ á³îëîã³ÿ
Çäàºòüñÿ, â ìåäèöèí³ ³ñíóº äâ³ (íå âçàºìîâèê-
ëþ÷í³) ìîäåë³: îäíà ç íèõ ïîâ’ÿçàíà ç á³îìåäèöè-
íîþ, à ³íøà ïðåäñòàâëÿº êë³í³÷íó ìåäèöèíó, âêëþ-
÷àþ÷è ô³çè÷íó òà ðåàá³ë³òàö³éíó ìåäèöèíó
(ÔÐÌ) 80 . Äàë³ áóäå îïèñàíî äîêëàäí³øå, ùî
ìàºòüñÿ íà óâàç³ ï³ä òåðì³íàìè «Á³îìåäèöèíà» ³
«Êë³í³÷íà ìåäèöèíà».
Äîì³íóþ÷îþ ìîäåëëþ º á³îìåäè÷íà – ì’ÿêèé
âàð³àíò íàóêîâî¿ ïàðàäèãìè, ùî äàòóºòüñÿ XVII
ñòîë³òòÿì, ÿêà º ðåäóêö³îí³ñòñüêîþ òà äåòåðì³í³-
ñòè÷íîþ. Ùîá çðîçóì³òè ö³ëå, íåîáõ³äíî ðîçãëÿíó-
òè éîãî ÷àñòèíè (ðåäóêö³îí³çì, ÿê â àíàòî쳿), ³
ïîâèíí³ áóòè âèÿâëåí³ çàãàëüí³ ³íâàð³àíòí³ çàêîíè,
ùî ðåãóëþþòü âçàºìî䳿 ì³æ ÷àñòèíàìè (äå-
òåðì³í³çì, ÿê â ô³ç³îëî㳿).  ïðèíöèï³, áóäü-ÿêèé
«ôåíîìåí» (ùî âèíèêàº, çã³äíî ç ãðåöüêîþ åòèìî-
ëî㳺þ) º ïîòåíö³éíî ïåðåäáà÷óâàíèì, îñê³ëüêè
â³äîáðàæຠô³çè÷í³ çàêîíè. Çã³äíî äî á³îìåäè÷íî¿
ìîäåë³, îäèíèöåþ ñïîñòåðåæåííÿ íå º ëþäèíà: íåþ
º ÷àñòèíà ëþäèíè (íåçàëåæíî â³ä òîãî, îðãàí àáî
ìîëåêóëà). Óÿâèìî ñîá³ ãðà䳺íò, ùî ðóõàºòüñÿ â³ä
ìîëåêóë äî ëþäèíè, à ïîò³ì äî ïîïóëÿö³é. Ó «ïî-
ïóëÿö³éí³é» êðàéíîñò³, ñôåðà åï³äåì³îëî㳿, îñíîâ-
íîþ òåìîþ çíîâó íå º ëþäèíà: ëþäèíè âèñòóïà-
þòü, ÿê òèðàæîâàí³ ³íäèâ³äóóìè, âëàñòèâîñò³ ÿêèõ
ìîæëèâî ï³äñóìóâàòè çà äîïîìîãîþ âèì³ðþâàíü
¿õ ãîëîâíèõ òåíäåíö³é (ñåðåäíº çíà÷åííÿ, ìåä³àíà).
Íàâïàêè, ìîäåëü êë³í³÷íî¿ ìåäèöèíè, íà â³äì³íó
â³ä á³îìåäè÷íî¿ ìîäåë³, âèçíà÷ຠîäíó ëþäèíó â
ö³ëîìó â ÿêîñò³ ïåðâèííîãî ³íòåðåñó, ³ ìຠçà ìåòó
çàñòîñóâàííÿ ïåðñîí-öåíòðè÷íî¿ äîïîìîãè ç îõî-
ðîíè çäîðîâ’ÿ (âêëþ÷íî ç³ ñï³ëüíèì ïðèéíÿòòÿì
ð³øåíü): ¿¿ çâ’ÿçîê ç ñîö³àëüíèìè àñïåêòàìè º íå-
â³ä’ºìíèì. ²íøèìè ñëîâàìè, äèñöèïë³íè, ùî íàëå-
æàòü äî êë³í³÷í³é ìåäèöèí³, òàê³ ÿê ÔÐÌ, íå îáìå-
æåí³ áóäü-ÿêèìè êîíêðåòíèìè «÷àñòèíàìè»
îðãàí³çìó òà îõîïëþþòü âçàºìîä³þ ïàö³ºíò-ñåðå-
äîâèùå (âêëþ÷íî ç â³äíîñèíàìè ïàö³ºíò-òåðàïåâò
³ îïòèìàëüíèì çáèðàííÿì ïîáàæàíü, ö³ííîñòåé ³
ö³ëåé ïàö³ºíòà). ̳æïåðñîíàëüí³ â³äíîñèíè (îäíå ç
«ë³êóâàííÿ òà äîïîìîãà») º ïåðåêîíëèâî óí³êàëü-
íèìè, ÷óòëèâèìè äî åìîö³éíèõ ³ êóëüòóðàëüíèõ ôàê-
òîð³â ³, â³äïîâ³äíèìè äî çðîñòàííÿ òàê çâàíî¿ á³î-
ïñèõî-ñîö³àëüíî¿ ìîäåë³ ìåäèöèíè. Çâè÷àéíî,
óí³òàðíèé «ôåíîìåí» (õâîðà ëþäèíà ³ éîãî/¿¿ îçíà-
êè òà ñèìïòîìè) ïðèõîâóº ïðîáëåìè â éîãî/¿¿ á³î-
ëîã³÷íèõ ÷àñòèíàõ, àëå ïîâåä³íêà ïàö³ºíòà òàêîæ
õàðàêòåðèçóºòüñÿ ñâîáîäîþ ³, îòæå, íåïåðåäáà÷ó-
âàí³ñòþ. Íå çîâñ³ì ÷³òêå ðîçóì³ííÿ ³ «ðåïàðàö³ÿ»
õâîðî¿ ëþäèíè º ñïåöèô³÷íîþ ìåòîþ êë³í³÷íî¿ ìå-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
äèöèíè, àëå äëÿ öüîãî ïîòð³áíî á³ëüø øèðîêèé
ï³äõ³ä, í³æ ïàðàäèãìà, ùî ëåæèòü â îñíîâ³ á³îëî-
ã³÷íèõ íàóê.
Öåé ðîçä³ë ï³äòâåðäæóº íàóêîâèé ñòàòóñ ÔÐÌ,
ïî ñóò³ êë³í³÷íî¿ ìåäè÷íî¿ ñïåö³àëüíîñò³, øëÿõîì
âèä³ëåííÿ ñïåöèô³êè ¿¿ äîñë³äíèöüêèõ ïàðàäèãì.
ÔÐÌ ñïðÿìîâàíà íà ïîñèëåííÿ ³íòåðåñó ³ çàëó÷åí-
íÿ äî äîñë³äæåíü ç ðåàá³ë³òàö³¿, îñê³ëüêè äîñë³ä-
æåííÿ º íåîáõ³äíèìè äëÿ ðîçóì³ííÿ ôóíäàìåíòàëü-
íèõ ïðîöåñ³â ðåàá³ë³òàö³¿, òàêèõ ÿê – íàïð.- ÿê ëþäè
çäîáóâàþòü íîâ³ íàâè÷êè, àáî, ÿê ð³çí³ òêàíèíè â
îðãàí³çì³ (íàïð. ì’ÿçè àáî íåðâîâ³ øëÿõè) ìîæóòü
â³äíîâëþâàòèñÿ ï³ñëÿ, àáî àäàïòóâàòèñÿ äî
íàñë³äê³â òðàâìè àáî çàõâîðþâàííÿ. Äîñë³äæåííÿ
ìîæóòü òàêîæ âèçíà÷àòè çàõâîðþâàí³ñòü òà ïîøè-
ðåí³ñòü îáìåæåíü æèòòºä³ÿëüíîñò³ òà ñòàí³â, ùî
ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³, à òàêîæ
íîâ³ òåõíîëî㳿 ðåàá³ë³òàö³¿, ùî ç’ÿâëÿþòüñÿ òà ïî-
âèíí³ áóòè àäàïòîâàí³ äëÿ âèêîðèñòàííÿ îñîáàìè
ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³. Á³ëüøå òîãî,
âàðò³ñòü ïîñëóã ç îõîðîíè çäîðîâ’ÿ òà ðåàá³ë³òàö³¿
ïîñò³éíî çðîñòàº, ³ ïîë³òèêè çìóøóþòü íàäàâà÷³â
ïîñëóã ç îõîðîíè çäîðîâ’ÿ îáìåæóâàòè ñâî¿ âèò-
ðàòè ³ ïîêàçàòè, ùî âîíè åôåêòèâíî îðãàí³çîâóþòü
öþ äîïîìîãó. ÔÐÌ º íàä³éíèì ïàðòíåðîì ó äèñ-
êóñ³¿ ç ïàö³ºíòàìè, ïîë³òèêàìè, ì³í³ñòåðñòâàìè
îõîðîíè çäîðîâ’ÿ òà ñòðàõîâèìè êîìïàí³ÿìè,
îñê³ëüêè âîíà ìຠçäàòí³ñòü ïóáë³÷íî ´ðóíòóâàòè
àðãóìåíòè íà äîñòîâ³ðíèõ äîêàçàõ, ÿê³ ìîæóòü çà-
áåçïå÷èòè ëèøå äîñë³äæåííÿ.
Äîñë³äæåííÿ ó ÔÐÌ: îäíà ³ òà æ ãðà,
ð³çí³ ïðàâèëà
ÔÐÌ ïîâí³ñòþ ñõâàëèëà ïðèíöèïè äîêàçîâî¿
ìåäèöèíè, òà äîñë³äæåííÿ â ÔÐÌ çðîáèëè çíà÷í³é
ïðîãðåñ ïðîòÿãîì îñòàíí³õ äåñÿòèë³òü81,82.  íàø³é
ñôåð³ öåé ïðîöåñ çíàíü ³ ïðèéíÿòòÿ ð³øåíü çàçâè-
÷àé íàìàãàºòüñÿ âêëþ÷àòè òðè íåâ³ä’ºìí³ ïîçèö³¿:
íàéêðàù³ íàóêîâ³ äîêàçè, ñïåö³àëüíèé êë³í³÷íèé
äîñâ³ä, ïîòðåáè ³ ïîáàæàííÿ ïàö³ºíò³â. Öåé ïðîöåñ
º ñêëàäíèì, îñê³ëüêè ÔÐÌ ìຠñâî¿ êîðåí³ â á³î-
ëî㳿 (ãëèáîêå çíàííÿ àíàòî쳿 ëþäèíè, ô³ç³îëî㳿 òà
ð³çíèõ ïàòîëîã³é), àëå òàêîæ ðîçïîâñþäæóºòüñÿ äî
ïîâåä³íêîâèõ íàóê83. Òàêà ïîäâ³éíà ïðèðîäà ÔÐÌ
º äæåðåëîì ÷àð³âíîñò³, àëå âèìàãຠâèñîêî¿ óí³âåð-
ñàëüíîñò³ ïðè ïðîâåäåíí³ äîñë³äæåíü çàëåæíî â³ä
ðîçòàøóâàííÿ òåìè äîñë³äæåííÿ íà äèñòàíö³¿ á³î-
ëîã³ÿ – ïîâåä³íêà. Âèâ÷åííÿ âïëèâó óäàðíèõ õâèëü
íà ì’ÿê³ òêàíèíè íå âèìàãຠòîãî ñàìîãî ìåòîäó,
ÿêèé ï³äõîäèòü äëÿ âèâ÷åííÿ çàëåæíîñò³ â ïîâñÿê-
äåííîìó æèòò³, äåô³öèòó óâàãè, áîëþ, âòîìè àáî
ñîö³àëüí³é âçàºìî䳿 ó ëþäåé. Îñòàíí³ âàð³àíòè
â³äíîñÿòüñÿ äî ëþäèíè â ö³ëîìó; îá’ºêò ñïîñòåðå-
æåííÿ º óí³òàðíèì ñóá’ºêòîì, ùî âçàºìî䳺 ç ñïî-
ñòåð³ãà÷åì. Ç öèõ ïðè÷èí ðåàá³ë³òàö³éíèì äîñë³ä-
179
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
æåííÿì íå çðó÷íî ïîºäíóâàòèñü ç äåÿêèìè ñòàí-
äàðòíèìè ï³äõîäàìè ôóíäàìåíòàëüíèõ íàóê òà
á³îìåäè÷íèìè äîñë³äíèöüêèìè ³íòåðâåíö³ÿìè.
Á³ëüø òîãî, ïîâåä³íêîâ³ äîñë³äæåííÿ ÷àñòî ðîç-
ãëÿäàþòüñÿ – â³äïîâ³äíî äî ðåäóêö³îí³ñòñüêî –
äåòåðì³í³ñòè÷íî¿ ìîäåë³ – ÿê «ÿê³ñí³» ç íåäîë³êîì
«ñóá’ºêòèâí³ñòü». ² íàâïàêè, íåìຠïðè÷èí, ÷îìó
ïîâåä³íêà ³ ñïðèéíÿòòÿ ëþäèíè íå ïîâèíí³ ï³äëÿãà-
òè ðåòåëüíîìó íàóêîâîìó äîñë³äæåííþ. Ïðîòå
³íñòðóìåíòè òà ìåòîäè ïîâèíí³ áóòè ïðèäàòíèìè
äëÿ ö³ëåé äîñë³äæåííÿ.
Êîðîòøå êàæó÷è, êëþ÷îâ³ â³äì³ííîñò³ ì³æ á³î-
ëîã³÷íèìè (á³îìåäèöèíà) ³ ïîâåä³íêîâèìè (êë³í³÷íà
ìåäèöèíà) äîñë³äíèöüêèìè ïàðàäèãìàìè ïîâ’ÿçàí³
ç: 1) çì³ííèìè, ùî àíàë³çóþòüñÿ; 2) ñòàòèñòè÷íè-
ìè ìåòîäàìè ³ 3) äèçàéíîì âèïðîáóâàíü80.
Äîñë³äæåííÿ ó ÔÐÌ: äâ³ ñòîðîíè
îäí³º¿ ìîíåòè
Òàêèì ÷èíîì, äîñë³äæåííÿ ÔÐÌ âèêîðèñòîâó-
þòü ìåòîäè, ùî ïîõîäÿòü ÿê ç á³îìåäè÷íî¿ ñôåðè,
òàê ³ ç êë³í³÷íèõ òà ïîâåä³íêîâèõ íàóê, ç ìåòîþ
ãåíåðóâàííÿ êîðèñíèõ äîêàç³â âèñîêî¿ ÿêîñò³. Á³î-
ìåäè÷í³ ìåòîäè º âàãîìèìè òà äîáðå â³äîìèìè,
´ðóíòîâàíèìè íà âñòàíîâëåíèõ äèñöèïë³íàõ, òà
ðîçïîâñþäæóþòüñÿ â³ä á³îìåõàí³êè äî íåéðîô³ç³î-
ëî㳿, â³ä á³îõ³ì³¿ äî åï³äåì³îëî㳿. ² íàâïàêè, ìåòî-
äè, ùî íàäõîäÿòü ç êë³í³÷íèõ ³ ïîâåä³íêîâèõ íàóê,
ïîòðåáóþòü ï³äñèëåííÿ ñïåöèô³÷íèìè äèçàéíàìè
äîñë³äæåíü, òà ç ãîðä³ñòþ ñòâåðäæóþòü, ùî º êëþ-
÷îâèì äæåðåëîì íàóêîâî¿ ³äåíòè÷íîñò³ ÔÐÌ.
Á³ëüø øèðîêå ðîçïîâñþäæåííÿ öèõ ïðîåêò³â ìîæå
òàêîæ ñïðèÿòè çì³öíåííþ êîìóí³êàö³¿ òà îáì³íó
çíàíü ç ³íøèìè íå-ìåäè÷íèìè ôàõ³âöÿìè, ÿê³ òà-
êîæ ïðàöþþòü ç îñîáàìè ç îáìåæåííÿìè æèòòº-
ä³ÿëüíîñò³.
Íàâ³òü ³ì’ÿ «Ô³çè÷íà ³ ðåàá³ë³òàö³éíà ìåäèöè-
íà» ïîòðåáóº ïåâíîãî â³äîáðàæåííÿ89: ÷è º ïðèê-
ìåòíèê «ô³çè÷íà» çàéâèì àáî îáìåæóâàëüíèì?
Çîâñ³ì í³, ÿêùî öåé òåðì³í ïîâ’ÿçàíèé ç éîãî ãðåöü-
êî¿ åòèìîëî㳺þ (physis îçíà÷ຠ«ïðèðîäó», âñåñâ³ò,
äî ÿêî¿ íàëåæèòü ëþäñòâî), ÿê ³ â ³íøèõ òåðì³íàõ,
íàïðèêëàä «ë³êàð» (physician) àáî «ô³ç³îëîã³ÿ»
(physiology). Ó öüîìó ñåíñ³ «ô³çè÷íèé» âêàçóº íà
òèï ìåäèöèíè, «ÿêà ïðàêòèêóºòüñÿ ç çîâí³øíüîãî
ñâ³òó, íà ëþäèíó â ö³ëîìó» (çã³äíî äî á³îïñèõîñî-
ö³àëüíî¿ ìîäåë³ ìåäèöèíè). Ç ³íøîãî áîêó, «ðåàá³-
ë³òàö³ÿ» âêàçóº íà ìåòó, ñïðÿìîâàíó íà â³äíîâëåííÿ
çäàòíîñò³ ëþäèíè (íàïð. íàéêðàùî¿ ìîæëèâî¿ âçàº-
ìî䳿 ç çîâí³øí³ì ñâ³òîì). Ïåðåòèí ì³æ ñàìèìè
ð³çíèìè «ô³çè÷íèìè» çàñîáàìè òà ö³ëëþ «ðåàá³ë³-
òàö³¿» º êóëüòóðàëüíèì ñòîâïîì ÔÐÌ. Ïðîòå, äåð-
æàâí³ óñòàíîâè òà íàäàâà÷³ ÷àñòî øóêàþòü äîêà-
çè ðåíòàáåëüíîñò³ ðåàá³ë³òàö³¿ òà çàçâè÷àé
âèìàãàþòü îö³íêè ïîñëóã â ö³ëîìó, îñê³ëüêè êîìàí-
180 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
äà, ùî çàéìàºòüñÿ òåðàﳺþ, ïîâèííà ìàòè øèðî-
êèé ñïåêòð ð³çíèõ òåõí³ê äëÿ çàäîâîëåííÿ ð³çíèõ ïî-
òðåá îñ³á ó áóäü-ÿê³é ãðóï³ ïàö³ºíò³â. Öå ä³éñíî º
ïðè÷èíîþ ïðîáëåìè, îñê³ëüêè ïðàêòèêà ô³çè÷íî¿ òà
ðåàá³ë³òàö³éíî¿ ìåäèöèíè äຠðåçóëüòàòè ÷åðåç
íèçêó âòðó÷àíü àáî âçàºìîä³þ ì³æ íèìè. Äåìîí-
ñòðàö³ÿ âïëèâó îäíîãî ðåàá³ë³òàö³éíîãî âòðó÷àííÿ
íå â³äïîâ³äຠ«ðåàëüíîìó æèòòþ», ³, õî÷à öå âàæ-
ëèâî äëÿ âèçíà÷åííÿ åôåêòèâíèõ ³íäèâ³äóàëüíèõ
ïðîöåäóð, ÿê³ ïîâèíí³ áóòè âêëþ÷åí³ äî ðåàá³ë³òà-
ö³éíî¿ ïðîãðàìè, öå ñàìî ïî ñîá³ íå ìîæå åôåêòèâ-
íî îö³íèòè ïðîãðàìó â ö³ëîìó. Íà â³äì³íó â³ä á³î-
ìåäè÷íèõ äîñë³äæåíü, äå ºäèíå ë³êóâàííÿ, ÿê
ïðàâèëî, òåñòóºòüñÿ íà áàãàòüîõ ëþäÿõ, ó ÔÐÌ äëÿ
îäí³º¿ îñîáè çàçâè÷àé çàñòîñîâóþòüñÿ ê³ëüêà ìå-
òîä³â òåðàﳿ. Òàêèì ÷èíîì, îäèíèöåþ òåðàﳿ ³ º
«ïðîãðàìà» â ö³ëîìó. Öå íå ïîâèííî âèêëèêàòè
ñóïåðå÷êè. Âîíà ïîâèííà ñë³äóâàòè ñóâîð³é ëîãèö³
àëãîðèòì³â ïðèéíÿòòÿ ð³øåíü: ð³çí³ âòðó÷àííÿ ïî-
âèíí³ ïðèçíà÷àþòüñÿ îêðåìèì îñîáàì, àëå â³äïî-
â³äíî äî â³äòâîðåíèõ ïðàâèë. ϳäáèâàþ÷è ï³äñóì-
êè, äëÿ ðîçðîáêè ïðàêòè÷íèõ íàñòàíîâ, âàæëèâî,
ùîá ÔÐÌ âèçíàâàëî òàêîæ ö³íí³ñòü äèíàì³÷íîãî
íàâ÷àííÿ (çà äîïîìîãîþ çàñòîñóâàííÿ òàê çâàíî-
ãî öèêëó «Ïëàíóâàòè – Ðîáèòè – Âèâ÷àòè – ijÿ-
òè») òà ðóõàëàñü â íàïðÿìêó ñèñòåìíèõ çíàíü, óç-
ãîäæóþ÷è âèêîðèñòàííÿ çàãàëüíèõ íàáîð³â ìåòîä³â
òà çàõîä³â äëÿ ðîçðîáêè òà ïîøèðåííÿ äîêàç³â88.
Òàêèì ÷èíîì, ñë³ä çàîõî÷óâàòè ñïåöèô³÷í³ äîñë³ä-
æåííÿ (òàêîæ çàïîçè÷åí³ ç ð³çíèõ äèñöèïë³í, âêëþ-
÷àþ÷è ñîö³àëüí³ íàóêè, à ïîò³ì îïòèì³çîâàí³ â³äïî-
â³äíî äî äîñë³äíèöüêèõ âèìîã ÔÐÌ), ÿê³
âèêîðèñòîâóþòü ñïåö³àëüí³ ïðàâèëà òà íàâè÷êè, ùî
ñòàíóòü êîìïîíåíòàìè äëÿ ñòâîðåííÿ íàâ÷àëüíî-
ãî ïëàíó ÔÐÌ, ¿õ ñë³ä çàîõî÷óâàòè ç êóëüòóðíî-
ïîë³òè÷íî¿ òà ô³íàíñîâî¿ òî÷êè çîðó.
Âèêëèêè äîêàçîâî¿ ìåäèöèíè â ÔÐÌ
“³äñóòí³ñòü äîêàç³â íå º äîêàçîì â³äñóò-
íîñò³”90. Öÿ ïðîâîêàö³éíà çàÿâà º îäí³ºþ ç ñòîðîí
ìîíåòè â ïîòî÷íèõ äåáàòàõ ç äîêàçîâî¿ ìåäèöèíè
(EBM). Ïðè á³ëüø óâàæíîìó ðîçãëÿä³ öå îçíà÷àº,
ùî â³äñóòí³ñòü çîâí³øí³õ äîêàç³â äëÿ îêðåìèõ
ôîðì òåðàﳿ íå º äîêàçîì ¿õ íååôåêòèâíîñò³.
Îòæå, ùî º êîíöåïö³ºþ EBM?
Çà ñëîâàìè ï³îíåð³â EBM Gordon Guyatt òà
David Sackett, ñï³âçàñíîâíèê³â ïåðøî¿ ì³æíàðîäíî¿
ðîáî÷î¿ ãðóïè EBM ( «ðîáî÷à ãðóïà ìåäèöèíè,
çàñíîâàíî¿ íà äîêàçàõ»), EBM º «ñóìë³ííèì, ÷³òêèì
òà îá´ðóíòîâàíèì âèêîðèñòàííÿì íàÿâíèõ êðàùèõ
äîêàç³â ïðè ïðèéíÿòò³ ð³øåíü ïðî äîïîìîãó îêðå-
ìèì ïàö³ºíòàì». Ïðàêòèêà äîêàçîâî¿ ìåäèöèíè
îçíà÷ຠ³íòåãðàö³þ ³íäèâ³äóàëüíîãî êë³í³÷íîãî äîñ-
â³äó òà ö³ííîñòåé ïàö³ºíò³â ç íàéêðàùèìè íàÿâíè-
¹2(2) *2018
 ÐÎÇÄ²Ë 10 – ÍÀÓÊÀ ÒÀ ÄÎÑ˲ÄÆÅÍÍß Ó ÔÐÌ: ÎÑÎÁËÈÂÎÑÒ² ÒÀ ÏÐÎÁËÅÌÈ
ìè çîâí³øí³ìè äîêàçàìè ç ñèñòåìàòè÷íèõ äîñë³ä-
æåíü91. Sackett ïðîäåìîíñòðóâàâ, ÿê ö³ òðè ãàëóç³
EBM ôîðìóþòü îö³íêó ìåòîä³â òåðàﳿ, òà ÿê âîíè
ìàþòü áóòè îö³íåí³ äëÿ êîæíîãî êîíêðåòíîãî ïà-
ö³ºíòà24. (Ìàëþíîê 1)
Êðàù³ çîâí³øí³ äîêàçè
EBM îïðèëþäíèâ ³ºðàðõ³þ êðàùèõ äîñë³äíèöü-
êèõ äîêàç³â ³ êëàñèô³êóâàâ ¿õ â³äïîâ³äíî äî ñòóïå-
íÿ ñâîáîäè â³ä ð³çíèõ óïåðåäæåíü, ïîâ’ÿçàíèõ ç
ìåäè÷íèìè äîñë³äæåííÿìè. Ïðî ÿê³ñòü çîâí³øí³õ
äîêàç³â ìîæëèâî ñóäèòè íà ð³çíèõ ð³âíÿõ:
– îêðåì³ äîñë³äæåííÿ;
– ñèñòåìàòè÷í³ îãëÿäè òà ìåòà-àíàë³çè;
– ðåêîìåíäàö³¿ ³ íàñòàíîâè.
Äëÿ êîæíîãî ç öèõ ð³âí³â áóëè ðîçðîáëåí³ ³íñòðó-
ìåíòè òà ìåòîäè îö³íêè. Ùîá ñóäèòè ïðî ÿê³ñòü
îêðåìîãî äîñë³äæåííÿ, áóëè îïóáë³êîâàí³ êîíò-
ðîëüí³ ëèñòè ïóíêò³â äëÿ çâ³ò³â âèïðîáóâàíü, ÿê³
äîïîìàãàþòü â÷åíèì ³ êë³í³öèñòàì ç îö³íêîþ, íà-
ïðèêëàä, øêàëà Physiotherapy Evidence Database
(PEDro).
Øêàëà PEDro áàçóºòüñÿ íà ïåðåë³êó Delphi,
ðîçðîáëåíîìó Verhagen òà êîëåãàìè â Department
of Epidemiology, University of Maastricht92. Öå ïå-
ðåë³ê êðèòåð³¿â äëÿ îö³íþâàííÿ ÿêîñò³ ðàíäîì³çî-
âàíèõ êë³í³÷íèõ âèïðîáóâàíü äëÿ ïðîâåäåííÿ ñèñ-
òåìàòè÷íèõ îãëÿä³â, ðîçðîáëåíèõ êîíñåíñóñîì
Delphi93,94.
 ÿêîñò³ àëüòåðíàòèâè Cochrane Collaboration
ïðîñóâຠ³íñòðóìåíòè îö³íêè ðèçèêó óïåðåäæåíîñò³
â îêðåìèõ äîñë³äæåííÿõ. Ö³ ³íñòðóìåíòè îö³íêè,
êð³ì ïðèéíÿòèõ ñõîæèõ ðåçóëüòàò³â, âíîñÿòü âêëàä
äî ôîðìóëþâàííÿ ñèñòåìàòè÷íèõ îãëÿä³â òà ìåòà-
àíàë³ç³â. Íåçâàæàþ÷è íà öå, ñèñòåìàòè÷í³ îãëÿäè
íå êëàñèô³êóþòü çàãàëüíó ÿê³ñòü äîêàç³â ïî ðå-
çóëüòàòàõ. Îñê³ëüêè ñèñòåìàòè÷í³ îãëÿäè íå ðîá-
ëÿòü àáî, ïðèíàéìí³, íå ïîâèíí³ ðîáèòè ðåêîìåí-
äàö³¿, ÿê³ñòü äîêàç³â îö³íþºòüñÿ ëèøå äëÿ êîæíîãî
ðåçóëüòàòó îêðåìî.
Òîìó ñë³ä âðàõîâóâàòè ïðîñò³ ñèñòåìè ãðàäàö³¿,
ùî îö³íþþòü çîâí³øí³ äîêàçè ç 1 ïî 4, ÿê ³ êðèòåð³¿
Îêñôîðäñüêîãî öåíòðó äîêàçîâî¿ ìåäèöèíè.
Íàðåøò³, äëÿ îòðèìàííÿ îãëÿäó âñ³º¿ ñóêóïíîñò³
äîêàç³â ç ïåâíî¿ òåìè, ðåçóëüòàòè ìîæóòü áóòè
óçàãàëüíåí³ ³ îö³íåí³ ð³çíèìè ñèñòåìàìè ãðàäàö³¿.
Öå çàâäàííÿ äëÿ ïàíåëåé ç³ ñòâîðåííÿ íàñòàíîâ, ÿê³
ïîâèíí³ âèçíà÷èòè çàãàëüíó ÿê³ñòü äîêàç³â ÷åðåç
óñ³ êðèòè÷í³ ðåçóëüòàòè, íåîáõ³äí³ äëÿ ðåêîìåí-
äàö³é, ñòâîðåíèõ çà ¿õ äîïîìîãîþ. Ïàíåë³ ç³ ñòâî-
ðåííÿ íàñòàíîâ íàäàþòü ºäèíó ãðàäàö³þ ÿêîñò³
äîêàç³â äëÿ êîæíî¿ ðåêîìåíäàö³¿, àëå ñèëà ðåêî-
ìåíäàö³¿ çàçâè÷àé çàëåæèòü â³ä äîêàç³â, ùî ñòîñó-
þòüñÿ íå ëèøå îäíîãî, àëå ³ áàãàòüîõ ðåçóëüòàò³â,
âàæëèâèõ äëÿ ïàö³ºíò³â, òà ÿêîñò³ äîêàç³â äëÿ êîæ-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
íîãî ç öèõ ðåçóëüòàò³â. Öÿ êîìïëåêñíà òà áàãàòî-
âèì³ðíà îö³íêà ïîòðåáóº ñïåö³àëüíèõ ³íñòðóìåíò³â
îö³íêè.
Øèðîêî çàñòîñîâóâàíà ìåòîäîëîã³ÿ, ÿêà òàêîæ
âèêîðèñòîâóºòüñÿ Cochrane Collaboration, – öå ñè-
ñòåìà Grading of Recommendations, Assessment,
Development, and Evaluation (GRADE) 95 . Öåé
³íñòðóìåíò áóâ ðîçðîáëåíèé äëÿ ðîáî÷èõ ãðóï
åêñïåðò³â òà íàóêîâèõ òîâàðèñòâ äëÿ îö³íêè ñó÷àñ-
íèõ äîêàç³â òà ôîðìóëþâàííÿ ðåêîìåíäàö³é òà
ïðîïîçèö³é äëÿ êë³í³÷íî¿ ïðàêòèêè96.
Ðåçóëüòàòàìè â ñèñòåì³ GRADE º ñèëà ðåêî-
ìåíäàö³é ³ ÿê³ñòü äîêàç³â.
ßê³ñòü äîêàç³â êëàñèô³êóºòüñÿ ÿê
– Âèñîêà: âïåâíåí³ñòü, ùî ñïðàâæí³é åôåêò
áëèçüêèé äî ïåðåäáà÷óâàíîãî åôåêòó;
– Ïîì³ðíà: ïîì³ðíà âïåâíåí³ñòü â ïåðåäáà÷ó-
âàíîìó åôåêò³. Ñïðàâæí³é åôåêò, éìîâ³ðíî, áóäå
áëèçüêèì äî ïåðåäáà÷óâàíîãî, àëå º éìîâ³ðí³ñòü,
ùî â³í áóäå çíà÷íî â³äð³çíÿòèñÿ;
– Íèçüêà: âïåâíåí³ñòü â ïåðåäáà÷óâàíîìó
åôåêò³ îáìåæåíà. Ñïðàâæí³é åôåêò ìîæå ñóòòºâî
â³äð³çíÿòèñÿ â³ä ïåðåäáà÷óâàíîãî;
– Äóæå íèçüêà: äóæå ìàëî âïåâíåíîñò³ â ïå-
ðåäáà÷óâàíîìó åôåêò³. Ñïðàâæí³é åôåêò, éìîâ³ð-
íî, áóäå çíà÷íî â³äð³çíÿòèñÿ â³ä ïåðåäáà÷óâàíîãî
åôåêòó.
Ñèëà ðåêîìåíäàö³é îçíà÷àº: ñèëà ðåêîìåíäàö³¿
â³ä³ãðຠñòóï³íü, â ÿê³é ïàíåëü ç³ ñòâîðåííÿ íàñòà-
íîâ âïåâíåíà, ùî áàæàí³ íàñë³äêè âòðó÷àííÿ ïåðå-
âèùóþòü íåáàæàí³ åôåêòè àáî íàâïàêè, ó ä³àïàçîí³
ïàö³ºíò³â, äëÿ ÿêèõ öÿ ðåêîìåíäàö³ÿ º ïðèçíà÷åíîþ.
Ñèñòåìà GRADE ïðîïîíóº âèêîðèñòîâóâàòè
òåðì³íè «ñèëüí³ òà ñëàáê³» ðåêîìåíäàö³¿.
Ñèëüíà ðåêîìåíäàö³ÿ – öå òà, äëÿ ÿêî¿ ïàíåëü
ç³ ñòâîðåííÿ íàñòàíîâ âïåâíåíà â òîìó, ùî áàæàí³
åôåêòè âòðó÷àííÿ ïåðåâàæóþòü éîãî íåáàæàí³
åôåêòè (ñèëüíà ðåêîìåíäàö³ÿ äëÿ âòðó÷àííÿ) àáî,
ùî íåáàæàí³ åôåêòè âòðó÷àííÿ ïåðåâàæóþòü éîãî
áàæàí³ åôåêòè (ñèëüíà ðåêîìåíäàö³ÿ ïðîòè âòðó-
÷àííÿ). Ïðèì³òêà: ñèëüí³ ðåêîìåíäàö³¿ íå îáîâ’ÿç-
êîâî º ðåêîìåíäàö³ÿìè ç âèñîêèì ïð³îðèòåòîì.
Ñèëüíà ðåêîìåíäàö³ÿ ïåðåäáà÷àº, ùî á³ëüøîñò³,
àáî âñ³ì ëþäÿì íàéêðàùå áóäå ñë³äóâàòè ðåêîìåí-
äîâàíèì êóðñîì ä³é.
Ñëàáêà ðåêîìåíäàö³ÿ º òàêîþ, äëÿ ÿêî¿ áàæàí³
åôåêòè, éìîâ³ðíî, ïåðåâàæóþòü íåáàæàí³ åôåêòè
(ñëàáêà ðåêîìåíäàö³ÿ äëÿ âòðó÷àííÿ) àáî íåáà-
æàí³ åôåêòè, éìîâ³ðíî, ïåðåâàæóþòü áàæàí³ åôåê-
òè (ñëàáêà ðåêîìåíäàö³ÿ ïðîòè âòðó÷àííÿ), àëå
³ñíóº ïîì³òíà íåâèçíà÷åí³ñòü.
Ñëàáêà ðåêîìåíäàö³ÿ ïåðåäáà÷àº, ùî íå âñ³ì
ëþäÿì áóäå êðàùå âñüîãî ñë³äóâàòè ðåêîìåíäî-
âàíèì êóðñîì ä³é. Ïîòð³áíî ðîçãëÿíóòè á³ëüø îáå-
ðåæíî, í³æ çàçâè÷àé, îáñòàâèíè, ïåðåâàãè òà
181
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ö³ííîñò³ îêðåìèõ ïàö³ºíò³â. Çà íàÿâíîñò³ ñëàáêèõ
ðåêîìåíäàö³é äîãëÿäà÷³ ïîâèíí³ âèä³ëÿòè á³ëüøå
÷àñó äëÿ ñï³ëüíîãî ïðèéíÿòòÿ ð³øåíü, ïåðåêîíàâ-
øèñü, ùî âîíè ÷³òêî ³ âñåá³÷íî ïîÿñíþþòü ïî-
òåíö³éí³ âèãîäè ³ øêîäè ïàö³ºíòó.
Îòæå, ñèñòåìà GRADE íå çä³éñíþº àâòîìàòè÷-
íó îö³íêó ÐÊÄ âèùå, í³æ îáñåðâàö³éí³ äîñë³äæåííÿ
(ÿê öå ðîáèòü Îêñôîðäñüêèé öåíòð äîêàçîâî¿ ìåäè-
öèíè). Íàïðèêëàä, ÐÊÄ ìîæóòü áóòè ïðåäñòàâëåí³
â íåâèã³äíîìó ñâ³òë³ ÷åðåç ðèçèê óïåðåäæåíîñò³,
íåñïðÿìîâàíîñò³, íåòî÷íîñò³ ³ óïåðåäæåíîñò³ ïóá-
ë³êàö³¿. Ó òîé æå ÷àñ, îáñåðâàö³éí³ äîñë³äæåííÿ
ìîæóòü áóòè ìîäåðí³çîâàí³ çà ðàõóíîê âåëè÷èíè
åôåêò³â, äîçî-çàëåæíîñò³ ³ ïîâ’ÿçàíèõ åëåìåíò³â.
Íàäçâè÷àéíî âàæëèâèì º, ùî ñèñòåìà GRADE
ñòâåðäæóº, ùî:
– êë³í³öèñòè, ïàö³ºíòè, ïëàòíèêè – òðåò³ îñîáè,
êîì³òåòè ç ³íñòèòóö³éíîãî îãëÿäó, ³íø³ çàö³êàâ-
ëåí³ ñòîðîíè àáî ñóäè í³êîëè íå ïîâèíí³ ðîçãëÿ-
äàòè ðåêîìåíäàö³¿ ÿê íàêàç. Íàâ³òü ñèëüí³ ðå-
êîìåíäàö³¿ íà îñíîâ³ âèñîêîÿê³ñíèõ äîêàç³â íå
çàñòîñîâóâàòèìóòüñÿ äî âñ³õ îáñòàâèí ³ äî âñ³õ
ïàö³ºíò³â;
– êîðèñòóâà÷³ íàñòàíîâ ìîæóòü îá´ðóíòîâàíî
çðîáèòè âèñíîâîê, ùî âèêîíàííÿ äåÿêèõ ðåêî-
ìåíäàö³é, çàñíîâàíèõ íà äîêàçàõ âèñîêî¿ ÿêîñò³,
áóäå ïîìèëêîâèì äëÿ äåÿêèõ ïàö³ºíò³â. ͳÿê³
êë³í³÷í³ íàñòàíîâè àáî ðåêîìåíäàö³¿ íå ìîæóòü
áðàòè äî óâàãè âñ³ íåïîâòîðí³ ³ óí³êàëüí³ îñîá-
ëèâîñò³ îêðåìèõ ïàö³ºíò³â ³ êë³í³÷íèõ îáñòàâèí.
Òàêèì ÷èíîì, í³õòî ç â³äïîâ³äàëüíèõ çà îö³íêó
ä³é êë³í³öèñòà, íå ïîâèíåí íàìàãàòèñÿ çàñòîñó-
âàòè ðåêîìåíäàö³¿ ÷èñòî ìåõàí³÷íî, ó âèãëÿä³
øàáëîíó.
Ñèòóàö³ÿ ç ô³çè÷íîþ òà ðåàá³ë³òàö³éíîþ
ìåäèöèíîþ
Íåìຠñóìí³â³â ùîäî âàæëèâîñò³ òà íåîáõ³ä-
íîñò³ äîêàçîâî¿ ìåäèöèíè (EBM) ó ïîçèö³îíóâàíí³
òà ðîçâèòêó ñïåö³àëüíîñò³ ÔÐM. Ó ìèíóëîìó âèï-
ðîáóâàííÿ âèñîêî¿ ÿêîñò³, îñîáëèâî ðàíäîì³çîâàí³
êîíòðîëüîâàí³ äîñë³äæåííÿ, áóëè ð³äê³ñíèìè, ùî
ïðèçâîäèëî äî äîì³íóâàííÿ êë³í³÷íîãî äîñâ³äó ³
ö³ííîñòåé ïàö³ºíò³â. Ó ÔÐÌ îñîáëèâî, âèïðîáóâàí-
íÿ íà âèñîêîìó íàóêîâîìó ð³âí³ íåñóòü áàãàòî âèê-
ëèê³â òà äèñêóñ³é, ³ òîìó ¿õ âàæêî âèêîíàòè.
Âèêëèêè ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè
Ïðèðîäà ñïåö³àëüíîñò³ ÔÐÌ ïðèíöèïîâî
â³äð³çíÿºòüñÿ â³ä ³íøèõ, íàïðèêëàä, â³ä âíóòð³øíüî¿
ìåäèöèíè àáî íàâ³òü õ³ðóð㳿. Ïðèçíà÷åííÿ ë³ê³â
ïàö³ºíòàì â³äíîñíî ëåãêî ñòàíäàðòèçóâàòè, ÿê
ùîäî äîçóâàííÿ, òàê é ùîäî â³äïîâ³äíîñò³, òà
îñë³ïëåííÿ ìîæå áóòè àäåêâàòíî âèêîíàíå.
182 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Òàêîæ õ³ðóðã³÷í³ âòðó÷àííÿ äîòðèìóþòüñÿ âè-
ñîêîñòàíäàðòèçîâàíèõ ïðîöåäóð ó â³äòâîðþâàíèõ
óìîâàõ. Íåùîäàâíî äîñë³äíèêè íàâ³òü çàñòîñóâà-
ëè ô³êòèâíå õ³ðóðã³÷íå âòðó÷àííÿ äëÿ êîíòðîëþ
ë³êóâàëüíèõ åôåêò³â (àðòðîñêîï³÷íà ÷àñòêîâà ìå-
í³ñêåêòîì³ÿ ïîð³âíÿëüíî ç ô³êòèâíîþ îïåðàö³ºþ ïðè
äåãåíåðàòèâíîìó ðîçðèâ³ ìåí³ñêó).
Ñïåö³àëüí³ñòü ÔÐÌ ïðèéíÿëà ÌÊÔ, ÿê êîíöåï-
ö³þ äëÿ ¿¿ êë³í³÷íî¿ ðîáîòè (íå çàñòîñîâóºòüñÿ äëÿ
ìåäè÷íî¿ ä³àãíîñòèêè, ïîñèëàºòüñÿ íà ïóáë³êàö³¿
êë³í³÷íèõ âèïàäê³â ç â³çóàë³çàö³ºþ, óëüòðàçâóêîì
òîùî). Öå ïåðåäáà÷ຠðÿä âïëèâîâèõ çì³ííèõ, â³ä
ñòðóêòóð òà ôóíêö³¿ îðãàí³çìó òà äî îñîáèñòèõ
ôàêòîð³â òà ôàêòîð³â ñåðåäîâèùà. Öÿ êîíöåïö³ÿ
â³äîáðàæຠðåàëüí³ñòü ïàö³ºíòà, àëå ñóïåðå÷èòü
ñòàíäàðòèçàö³¿ ïðîöåäóð.
Áàãàòî ³íòåðâåíö³é ÔÐÌ º íåîäíîð³äíèìè ó çà-
ñòîñóâàíí³, äîçóâàíí³ (³íòåíñèâí³ñòü, òðèâàë³ñòü,
÷àñòîòà çàñòîñóâàííÿ) òà ³íäèâ³äóàëüíèõ ïåðåâà-
ãàõ, ÿê äëÿ êë³í³öèñò³â, òàê ³ äëÿ ïàö³ºíò³â. Ôóíäà-
ìåíòàëüí³ åêñïåðèìåíòàëüí³ äàí³ ïðî åôåêòè âòðó-
÷àííÿ º ð³äêèìè. Öå óñêëàäíþº ðîçðîáêó
åôåêòèâíîãî ìåòîäó ïëàöåáî, ÿêùî îñíîâíèé ìå-
õàí³çì íå º çðîçóì³ëèì. ×àñòî ñó÷àñí³ òà íàóêîâî
îá´ðóíòîâàí³ çíàííÿ ïðî ô³çè÷í³ ìîäàëüíîñò³ ïîõî-
äÿòü â³ä ³íøèõ ñïåö³àëüíîñòåé. Íàïðèêëàä, äîñë³ä-
æåííÿ, ïðèñâÿ÷åí³ «ñîíîïîðàö³¿» (òðàíñïîðòóâàí-
íÿ ë³ê³â ÷åðåç øê³ðó çà äîïîìîãîþ óëüòðàçâóêó) â
äàíèé ÷àñ ñèëüíî ï³äòðèìóþòü â÷åí³-îíêîëîãè. Öåé
íàóêîâèé ï³äõ³ä çàáåçïå÷óº íàóêîâ³ ìîäåë³, ÿê³
ìîæóòü áóòè ëåãêî ïðèéíÿò³ äëÿ çàâäàíü ÔÐÌ,
íàïð. äîñòàâêà ë³ê³â ïðè ì’ÿçîâî-ñêåëåòíèõ ïðî-
áëåìàõ.
ʳëüê³ñòü äîñë³äíèê³â º â³äíîñíî íåâåëèêîþ,
õî÷à ³ øâèäêî çðîñòàº.
Ô³íàíñóâàííÿ âèïðîáóâàíü, îñîáëèâî ôóíäà-
ìåíòàëüíèõ åêñïåðèìåíòàëüíèõ äîñë³äæåíü, º çà-
íàäòî ìàëèì ³ íå ìîæå çð³âíÿòèñÿ ç ôàðìàöåâòè÷-
íèìè âèïðîáóâàííÿìè.
Ãîëîâíèì çàâäàííÿì ó ïðîâåäåíí³ âèñîêîÿê³ñ-
íèõ êë³í³÷íèõ âèïðîáóâàíü º ðîçóì³ííÿ ïëàöåáî ó
íàø³é ñïåö³àëüíîñò³. Fregni, Imamura ç ñï³âàâò.
îïóáë³êóâàëè ôóíäàìåíòàëüíèé äîêóìåíò â ðå-
çóëüòàò³ ðîáîòè International Placebo Symposium
Working Group ùîäî ðåêîìåíäàö³é òà âèêëèê³â äëÿ
ïëàöåáî-êîíòðîëþ â ÔÐÌ97. Âîíè âèÿâèëè ê³ëüêà
ïðîáëåì, ïîâ’ÿçàíèõ ³ç çàñòîñóâàííÿì ïëàöåáî â
êë³í³÷íèõ âèïðîáóâàííÿõ ó ÔÐÌ. Äåÿê³ ç íèõ â³äîá-
ðàæàþòü ñòðóêòóðó, êîíöåïö³þ òà ïðèíöèïè ðîáî-
òè ñïåö³àëüíîñò³.
– Ðîçâèòîê ïëàöåáî ³ ô³êòèâíèõ ïðèñòðî¿â;
– ³äñóòí³ñòü ñòàíäàðò³â äëÿ âòðó÷àíü â ÔÐÌ;
– Íåîäíîð³äí³ñòü âòðó÷àíü ÷åðåç â³äì³ííîñò³
â íàâè÷êàõ òåðàïåâòà;
– Ïðîáëåìè ç àäåêâàòíèì ìàñêóâàííÿì;
¹2(2) *2018
 ÐÎÇÄ²Ë 10 – ÍÀÓÊÀ ÒÀ ÄÎÑ˲ÄÆÅÍÍß Ó ÔÐÌ: ÎÑÎÁËÈÂÎÑÒ² ÒÀ ÏÐÎÁËÅÌÈ
– Îñîáèñòà âçàºìîä³ÿ ì³æ òåðàïåâòîì ³ ïàö³ºíòîì;
– Îñîáèñò³ ïåðåêîíàííÿ, ïîïåðåäí³é äîñâ³ä òà
ìîòèâàö³ÿ;
– Ìàë³ îáñÿãè åôåêò³â;
– Òðèâàë³ ñïîñòåðåæåííÿ;
– ³äñóòí³ñòü ï³äãîòîâêè äëÿ ïðîâåäåííÿ
êë³í³÷íèõ äîñë³äæåíü;
– Âèêîðèñòàííÿ ìåäè÷íèõ ïðèëàä³â.
Êð³ì òîãî, äåÿê³ êë³í³÷í³ ñòàíè ïðîñòî íå äîç-
âîëÿþòü âèêîðèñòîâóâàòè ïëàöåáî àáî ô³êòèâíèé
ïðèñòð³é.
Ö³ ñòàíè âêëþ÷àþòü âèïðîáóâàííÿ, ùî òåñòó-
þòü ã³äðîòåðàïåâòè÷í³ âòðó÷àííÿ, åôåêòèâí³ñòü
ïðîòåçà íèæíüî¿ ê³íö³âêè àáî âèêîðèñòàííÿ ô³êòèâ-
íîãî îðòåçó äëÿ ïàäàþ÷î¿ ñòîïè.
Ùå îäí³ºþ ïðîáëåìîþ º âèêîðèñòàííÿ êîìá³-
íîâàíèõ âòðó÷àíü. Ó êë³í³÷í³é ïðàêòèö³ âòðó÷àííÿ
ÔÐÌ ÷àñòî ïîºäíóþòüñÿ îäíî ç îäíèì, àáî ïðè-
çíà÷àþòüñÿ â ïîºäíàíí³ ç ìåäèêàìåíòîçíîþ òåðà-
ﳺþ. Îñê³ëüêè ³ñíóº áåçë³÷ ìîæëèâîñòåé ïîºäíàí-
íÿ âòðó÷àíü, ó ìèíóëîìó íå áóëî ìîæëèâîñò³
ïðîåêòóâàííÿ êë³í³÷íèõ âèïðîáóâàíü âñ³õ ìîæëè-
âèõ êîìá³íàö³é. Ö³ äèçàéíè ðîáëÿòü ³íòåðïðåòàö³þ
êîæíîãî îêðåìîãî ìåòîäó äóæå ñêëàäíîþ. ×àñòî
çàëèøàºòüñÿ ïèòàííÿ, ÷è âïëèâàþòü ³íòåðâåíö³¿, ÿê³
âèêîðèñòîâóþòüñÿ, îäíà íà îäíó. Á³ëüø òîãî,
ë³êàð³ ÔÐÌ, á³ëüø í³æ â ³íøèõ ñïåö³àëüíîñòÿõ,
÷àñòî ìàþòü ñïðàâó ç ïàö³ºíòàìè ç áàãàòüìà õâî-
ðîáàìè. Ç î÷åâèäíèõ ïðè÷èí ïðîåêòóâàííÿ òà ïðî-
âåäåííÿ àäåêâàòíèõ äîñë³äæåíü ç â³äïîâ³äíèìè
ó÷àñíèêàìè ìîæå áóòè äóæå ïðîáëåìàòè÷íèì.
Áàãàòî ç âèùåçãàäàíèõ ïðè÷èí îáóìîâëþþòü
òîé ôàêò, ùî íåàäåêâàòíèé äèçàéí äîñë³äæåííÿ,
íåâåëèêà ê³ëüê³ñòü ó÷àñíèê³â, ð³çí³ äèçàéíè äëÿ
ïàðàëåëüíèõ ãðóï òà íåäîñòàòíº îñë³ïëåííÿ òà ïëà-
öåáî êîíòðîëü îáóìîâèëè, ñåðåä ³íøîãî, íèæ÷ó
ÿê³ñòü âèïðîáóâàíü, îñîáëèâî â ïîð³âíÿíí³ ç
ôàðìàêîëîã³÷íèìè äîñë³äæåííÿìè. Çãîäîì äîñë³ä-
æåííÿ, ïðîâåäåí³ â ìèíóëîìó â íàø³é ãàëóç³, ÷àñ-
òî íå âêëþ÷àëèñÿ äî ìåòà-àíàë³ç³â, â³äïîâ³äíî,
áàãàòî íàøèõ ñïåöèô³÷íèõ ìåòîä³â ë³êóâàííÿ íå
ìàþòü á³ëüø âèñîêîãî ñòóïåíÿ äîêàç³â. ßê íà-
ñë³äîê, öå ïðèçâîäèòü äî ïîã³ðøåííÿ âèçíàííÿ
êë³í³öèñòàìè òà äîñë³äíèêàìè ó íàóêîâ³é ñï³ëüíîò³
òà íåäîñòàòíº ïðåäñòàâëåííÿ â ï³äðó÷íèêàõ EBM.
Çà ÷àñ³â çðîñòàþ÷èõ ô³íàíñîâèõ ñêîðî÷åíü ìî-
æóòü âèíèêíóòè òåíäåíö³¿ çëîâæèâàòè ö³ºþ «â³äñóò-
í³ñòþ äîêàç³â» ç áîêó çàö³êàâëåíèõ ñòîð³í ñèñòåì
îõîðîíè çäîðîâ’ÿ äëÿ çíèæåííÿ âèòðàò. Ç öüîãî
ñòàâëåííÿ ìîæå â³äáóòèñÿ çíà÷íèé òèñê ç áîêó
îõîðîíè çäîðîâ’ÿ ùîäî íåô³íàíñóâàííÿ ä³àãíîñ-
òè÷íèõ òà òåðàïåâòè÷íèõ ïðîöåäóð ó ñôåð³ ÔÐÌ.
Îêð³ì ìåòîäîëîã³÷íèõ íåäîë³ê³â ó äîñë³äæåí-
íÿõ ÔÐÌ, ð³çíèöÿ ì³æ îðãàííîþ ìåäèöèíîþ òà
ÔÐÌ òàêîæ çì³öíþºòüñÿ òèì, ùî íà ïåðøó çíà÷-
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
íîþ ì³ðîþ âïëèâàþòü ³íòåðåñè âèðîáíèê³â, ùî
ìîæå ïîÿñíèòè ö³ ð³çíîìàí³òí³ ð³âí³ äîêàçîâèõ
çíàíü 98.
ßê âèð³øèòè ö³ ïðîáëåìè
Íà ùàñòÿ, ïðîòÿãîì îñòàíí³õ äåñÿòèë³òü áóëè
çä³éñíåí³ çíà÷í³ çóñèëëÿ äëÿ çá³ëüøåííÿ ê³ëüêîñò³
âèñîêîÿê³ñíèõ äîñë³äæåíü òà ÐÊÄ ó ö³é ñôåð³. Áóâ
äîñÿãíóòèé ïðîãðåñ â ðîçðîáö³ äèçàéíó äîñë³äæåíü
³ ñòàòèñòè÷íî¿ ìåòîäîëî㳿. Òàêîæ íà ðåçóëüòàòè
âïëèâàþòü êðèòå𳿠âêëþ÷åííÿ òà âèêëþ÷åííÿ â
îãëÿäàõ. Îäíèì ³ç ïðèêëàä³â òàêîãî âïëèâó âèñîêî-
ÿê³ñíèõ äîñë³äæåíü, ùî âïëèâàþòü íà ðåçóëüòàòè
ìåòà-àíàë³çó, º íåùîäàâíº äðóãå îíîâëåííÿ Êîêðà-
íîâñüêîãî îãëÿäó ùîäî ÷åðåçøê³ðíî¿ åëåêòðîñòèìó-
ëÿö³¿ íåðâó (TENS) ïðè ãîñòðîìó áîëþ.  îñòàíí³
ðîêè äàí³ áóëè íåäîñòàòí³ìè äëÿ ï³äòðèìêè åôåê-
òèâíîñò³ çàñòîñóâàííÿ TENS ïðè ãîñòðîìó áîëþ.
Çá³ëüøèâøè ê³ëüê³ñòü âèñîêîÿê³ñíèõ ÐÊÄ òà âèêëþ-
÷èâøè äîñë³äæåííÿ ç íåäîñòàòíüîþ äîçîþ TENS,
Êîêðàí³âñüêèé âèñíîâîê ïîïåðåäíüî¿ ðåêîìåíäàö³¿
ùîäî âèêîðèñòàííÿ TENS áóëî îíîâëåíî99.
Ïîêðàùåííÿ ñòàíäàðò³â ó äîñë³äæåííÿõ
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
Îñíîâíèì øëÿõîì äëÿ ïîêðàùåííÿ îö³íêè ÔÐÌ
º ÿê³ñíå òà ê³ëüê³ñíå ïîêðàùåííÿ êë³í³÷íèõ äîñë³-
äæåíü, ÿê íà ð³âí³ ôóíäàìåíòàëüíî¿ íàóêè â ëàáî-
ðàòîð³ÿõ, òàê ³ íà êë³í³÷íîìó ð³âí³.
Îñòàííº ðîáèòü ñüîãîäí³ ïðîâåäåííÿ âèñîêî-
ÿê³ñíèõ êë³í³÷íèõ âèïðîáóâàíü, òàêèõ, ÿê ðàíäîì³-
çîâàí³ êë³í³÷í³ âèïðîáóâàííÿ ç ïëàöåáî êîíòðîëåì,
àáî ñèìóëÿö³ºþ, îáîâ’ÿçêîâèì. Ò³ëüêè ö³ âèïðî-
áóâàííÿ ìàþòü øàíñ áóòè âêëþ÷åíèìè äî ìåòà-
àíàë³ç³â, íàïð. Êîêðàí³âñüê³õ îãëÿä³â, ùî çàáåçïå-
÷óþòü îñíîâó ðåêîìåíäàö³é òà íàñòàíîâ. Öå
âàæëèâî, îñê³ëüêè êë³í³÷í³ ðåêîìåíäàö³¿ òà íàñòà-
íîâè âïëèâàþòü íà ìåäè÷íó îñâ³òó, çàáåçïå÷óþ-
÷è âïðîâàäæåííÿ äî ïîâñÿêäåííî¿ êë³í³÷íî¿ ïðàê-
òèêè.
Ñòâîðåííÿ ÿê³ñíèõ äèçàéí³â äîñë³äæåíü,
ñïåöèô³÷íèõ äëÿ ÔÐÌ
Ïî ñóò³, íå ñë³ä ïîìèëÿòèñÿ, ÿêùî ïåðåíîñèòè
âñ³ ïðèíöèïè âèñîêîÿê³ñíèõ âèïðîáóâàíü ôàðìàêî-
òåðàﳿ áåçïîñåðåäíüî äî ñôåðè ÔÐÌ. Íåîáõ³äíî
âðàõîâóâàòè ê³ëüêà â³äì³ííîñòåé, ùî âèìàãàþòü
ñïåöèô³÷íî¿ êîíöåïö³¿ ïîäâ³éíèõ ñë³ïèõ ðàíäîì³çî-
âàíèõ êîíòðîëüîâàíèõ äîñë³äæåíü (ÐÊÄ) ó ñôåð³
ÔÐÌ. Âçàãàë³, íàóêîâö³ äîêëàëè çóñèëü ùîäî ðîç-
ðîáêè ðåêîìåíäàö³é, ÿê³ âèçíà÷àþòü ð³çíèöþ ì³æ
ôàðìàêîëîã³÷íèìè òà íå ôàðìàêîëîã³÷íèìè âèïðî-
áóâàííÿìè òà ñïðèÿþòü ðåêîìåíäàö³ÿì, ùîäî ¿õ
ïðîâåäåííÿ100. Öÿ ãðóïà òàêîæ íàäຠðåêîìåíäàö³é
183
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ùîäî ï³äãîòîâêè äèçàéíó òà ðåàë³çàö³¿ ç óðàõóâàí-
íÿì ïðèðîäè íå ôàðìàêîëîã³÷íèõ âèïðîáóâàíü.
Ñòàíäàðòèçóâàòè âòðó÷àííÿ
Âòðó÷àííÿ â ÔÐÌ çàçâè÷àé íå º îäíîð³äíèìè.
³äïîâ³äàëüíèìè çà öå º â³äñóòí³ñòü ôóíäàìåí-
òàëüíèõ íàóêîâèõ äàíèõ, âïîäîáàííÿ ïàö³ºíò³â òà
êë³í³öèñò³â, ðåêîìåíäàö³¿ âèðîáíèê³â òîùî. ßê ïðè-
êëàä – äëÿ íåðâîâî-ì’ÿçîâî¿ åëåêòðè÷íî¿ ñòèìó-
ëÿö³¿ ì’ÿç³â-ðîçãèíà÷³â ïðè îñòåîàðòðîç³ êîë³íà,
îïðèëþäíåí³ áåçë³÷ àìïë³òóä, ÷àñòîò, ðîçì³ð³â òà
ðîçì³ùåíü åëåêòðîäó. Äîòåïåð ëèøå ê³ëüêà îãëÿä³â
ðîáèëè ñïðîáè âèçíà÷èòè ïàðàìåòðè, ÿê³ çàáåçïå-
÷óþòü íàéêðàù³ êë³í³÷í³ åôåêòè âòðó÷àííÿ101. Öÿ
ñòàíäàðòèçàö³ÿ íåîáõ³äíà äëÿ ïðîâåäåííÿ âèïðî-
áóâàíü ³ç âòðó÷àííÿìè, ÿê³ ìîæëèâî ïîð³âíÿòè.
Äëÿ ñòàíäàðòèçàö³¿ òåðàïåâòè÷íèõ âòðó÷àíü
ìîæóòü áóòè ïðèéíÿò³ ðåêîìåíäàö³¿ òà íàñòàíîâè
ñóì³æíèõ íàóêîâèõ òîâàðèñòâ. Íàïð. American
Heart Association òà American College of Sports
Medicine îïóáë³êóâàëè ÷³òê³ ðåêîìåíäàö³¿ ùîäî
ïðèçíà÷åííÿ òåðàﳿ ç âïðàâàìè äëÿ ð³çíèõ ãðóï
õâîðèõ 102. Ö³ íàñòàíîâè ïîâèíí³ áóòè ïðèéíÿò³
ÔÐÌ, ÿê ñòàíäàðòí³ ïðîöåäóðè.
Ïðåäñòàâíèöòâî ÔÐÌ â «ñâ³ò³ äîêàçîâî¿
ìåäèöèíè»
Äîòåïåð ñïåö³àëüí³ñòü ÔÐÌ íå áóëà ÷³òêî ³
îäíîçíà÷íî ïðåäñòàâëåíà â ð³çíèõ áàçàõ äàíèõ
EBM. Õòîñü øóêàâ «ô³ç³îòåðàï³þ», «ô³çè÷íó òåðà-
ï³þ», «ðåàá³ë³òàö³þ» àáî «âïðàâè», ùîá çíàéòè äàí³
EBM â íàø³é ñôåð³. Çàïóñê Êîêðàí³âñüêî¿ ÔÐÌ
ñôåðè – öå âàæëèâèé êðîê äëÿ ïîäîëàííÿ ö³º¿ ïðî-
áëåìè. Ó ìåæàõ Êîêðàí³âñüêèõ ñôåð ³ ìåðåæ Êî-
êðàí³âñüêó ðåàá³ë³òàö³éíó ñôåðó áóëî ñòâîðåíî â
2016 ðîö³ ³ âîíà ìîæå ñëóãóâàòè ñôåðîþ, ìåòîþ
ÿêî¿ º ôóíêö³îíóâàííÿ, ÿê ì³ñò ì³æ çàö³êàâëåíèìè
ñòîðîíàìè òà Cochrane1. Íàÿâí³ äîêàçè ùîäî ðåà-
á³ë³òàö³¿ áóäóòü ðîçïîâñþäæóâàòèñü äëÿ ð³çíèõ
çàö³êàâëåíèõ ôàõ³âö³â îõîðîíè çäîðîâ’ÿ çà äîïîìî-
ãîþ îñâ³òí³õ, êîìóí³êàö³éíèõ àáî ïóáë³êàö³éíèõ
ñòðàòåã³é. Òàêîæ áóäóòü ðîçãëÿäàòèñü ìåòîäî-
ëîã³÷í³ ïðîáëåìè.
Ïåðåäà÷à íàóêîâèõ çíàíü äî êë³í³÷íî¿
ïðàêòèêè
ϳñëÿ ïåðåäà÷³ öèõ çíàíü äî êë³í³÷íî¿ ïðàêòèêè
âàæëèâî ïåðåäàòè äîêàçè òà íàñòàíîâè. Îñîáëè-
âî â ÔÐÌ, öå íå ò³ëüêè âêëþ÷ຠë³êàð³â ÔÐÌ, àëå,
á³ëüø òîãî, âñþ ðåàá³ë³òàö³éíó êîìàíäó. Öå
ï³äêðåñëþº âàæëèâ³ñòü ñïåö³àë³ñòà ÔÐÌ, ÿê ë³äå-
ðà òåðàïåâòè÷íî¿ êîìàíäè, ÿêà, â³äïîâ³äíî, ïðîìî-
òóº ïðîöåäóðè, ùî áàçóþòüñÿ íà äîêàçîâ³é ìåäè-
öèí³, äî òåðàïåâòè÷íîãî òà ðåàá³ë³òàö³éíîãî
184 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ïðîöåñó. Öå âèìàãຠíàëåæíèõ êîìóí³êàòèâíèõ íà-
âè÷îê äëÿ ïåðåêîíàííÿ âñ³õ ÷ëåí³â êîìàíäè òà
âïðîâàäæåííÿ öüîãî äî ïîâñÿêäåííîãî æèòòÿ.
 ÿêîñò³ ï³äòðèìêè ìîæëèâå ñòâîðåííÿ
íàö³îíàëüíèõ ðîáî÷èõ ãðóï äëÿ ñïðèÿííÿ öüîìó
ïðîöåñó.
Âèñíîâîê
EBM º ÷àñòèíîþ ñó÷àñíî¿ ìåäèöèíè, à îòæå, ³
÷àñòèíîþ ÔÐÌ. Òèì íå ìåíøå, ìè ïîâèíí³ áóòè
ñâ³äîì³, ùî EBM ÷àñòî çâîäèòüñÿ äî çîâí³øí³õ
äîêàç³â íà îñíîâ³ ìåòà-àíàë³ç³â òà ðàíäîì³çîâàíèõ
ïëàöåáî-êîíòðîëüîâàíèõ äîñë³äæåíü. Äîñë³äæåí-
íÿ ó ÔÐÌ íå ìîæíà ïîð³âíþâàòè ç ôàðìàöåâòè÷-
íèìè. ³äïîâ³äíî äî ö³ë³ñíîãî ï³äõîäó äî ïàö³ºíò³â,
ìຠáóòè ðåàë³çîâàíà êîíöåïö³ÿ ö³ë³ñíîãî äîñë³ä-
æåííÿ, â³ä ôóíäàìåíòàëüíèõ äîñë³äæåíü äî ìåòà-
àíàë³ç³â, ùî â³äîáðàæຠñòðóêòóðó ÔÐÌ.  ÿêîñò³
âàæëèâîãî êðîêó âïåðåä, ñòâîðåííÿ Êîêðàí³âñüêî¿
ðåàá³ë³òàö³éíî¿ ñôåðè äàñòü ìîæëèâ³ñòü íå ò³ëüêè
ïóáë³êóâàòè, â ïîäàëüøîìó, îãëÿäè çà âàæëèâèìè
òåìàìè, àëå é âïðîâàäèòè ïðèíöèïè ³ ö³ííîñò³ ÔÐÌ
â ñï³ëüíîò³ EBM.
Äîñë³äíèöüêà ï³äãîòîâêà
Á³ëüø³ñòü ìîëîäèõ ë³êàð³â, ùî íàâ÷àëèñü ó
ªâðîï³, ïðîõîäèëè íåáàãàòî, àáî çîâñ³ì íå ïðîõî-
äèëè ôîðìàëüíîãî íàâ÷àííÿ ìåòîäîëî㳿 äîñë³ä-
æåíü. Ò³ëüêè ìåíø³ñòü ñòóäåíò³â çàëó÷àëèñü äî
ôàêòè÷íèõ äîñë³äíèöüêèõ ïðîåêò³â ï³ä ÷àñ íàâ÷àí-
íÿ, òà, çàçâè÷àé, âèïàäêîâî. Ïðîòå, ñèòóàö³ÿ â áà-
ãàòüîõ êðà¿íàõ ïîñòóïîâî ïîë³ïøóºòüñÿ çàâäÿêè
ââåäåííÿ êàôåäðàìè êîìïîíåíòó ôóíäàìåíòàëü-
íèõ äîñë³äæåíü äî ïðîãðàìè äîäèïëîìíîãî ìåäè÷-
íîãî íàâ÷àííÿ, à òàêîæ äî ï³ñëÿäèïëîìíî¿ ïðîãðà-
ìè. Öå íàäຠâ³êíî ìîæëèâîñòåé äëÿ äèñöèïë³íè
Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà (ÔÐÌ), îñê³ëü-
êè áàãàòî ñòóäåíò³â äóæå çàö³êàâëåí³ â ó÷àñò³ ó
êë³í³÷íèõ ïðîåêòàõ, ÿê öå â³äáóâàºòüñÿ â íàø³é
îáëàñò³, ³ ìîæëèâ³ñòü áðàòè ó÷àñòü ó äîñë³äæåí-
íÿõ, éìîâ³ðíî, º ñèëüíèì ìîòèâóþ÷èì ôàêòîðîì.
Òîìó ðåêîìåíäóºòüñÿ, ùîá àêàäåì³÷í³ â÷èòåë³
òà ñòàðø³ êîëåãè, ÿê³ ìàþòü àêàäåì³÷íèé ³íòåðåñ
äî ÔÐÌ, ïðîïîíóâàëè ñòóäåíòàì-ìåäèêàì ìîæ-
ëèâ³ñòü áðàòè ó÷àñòü ó ïîòî÷íîìó ðåàá³ë³òàö³éíî-
ìó ïðîåêò³, çàëó÷àþ÷è ¿õ íå ò³ëüêè äî çáèðàííÿ
äàíèõ, àëå é äëÿ àíàë³çó äàíèõ òà, íàâ³òü, ðîçðîá-
êè íàóêîâîãî òåêñòó. Íåîáõ³äíî âèìàãàòè, ùîá
äîëó÷åííÿ äî äîñë³äíèöüêî¿ ï³äãîòîâêè ñòàëî îáî-
â’ÿçêîâîþ ÷àñòèíîþ ï³ñëÿäèïëîìíî¿ ï³äãîòîâêè ç
ÔÐÌ. Öå ó ïîäàëüøîìó ìîæå ïðèçâåñòè äî ìîæ-
ëèâîñò³ çàëó÷åííÿ òàêèõ ìîëîäèõ ñï³âðîá³òíèê³â äî
äèñåðòàö³éíî¿ ä³ÿëüíîñò³ â ãàëóç³ ô³çè÷íî¿ òà ðåà-
¹2(2) *2018
 ÐÎÇÄ²Ë 10 – ÍÀÓÊÀ ÒÀ ÄÎÑ˲ÄÆÅÍÍß Ó ÔÐÌ: ÎÑÎÁËÈÂÎÑÒ² ÒÀ ÏÐÎÁËÅÌÈ

Òàáëèöÿ ².

Òàáëèöÿ ²À ï³äñóìîâóº îñíîâí³ â³äì³ííîñò³. «Çì³íí³», ïîâ’ÿçàí³ ç ëþäèíîþ, º òàê çâàíèìè «ëàòåíòíèìè» çì³ííèìè àáî «ðèñàìè» (84).
¯õ íå ìîæíà ïîâí³ñòþ ñïîñòåð³ãàòè, âîíè íå º «ìàí³ôåñòíèìè»: â ëþäèí³ ïðèõîâàí³ íåçàëåæí³ñòü, á³ëü, âòîìà, ð³âíîâàãà, ìîâí³
íàâè÷êè òîùî. Âèñíîâêè ùîäî ¿õ ïðèñóòíîñò³ ³ ¿õ ê³ëüêîñò³ ìîæëèâî çðîáèòè ò³ëüêè ç ïîâåä³íêè ïðåäñòàâíèêà, ÿêó ìîæëèâî
ñïîñòåð³ãàòè. Çàçâè÷àé, âîíè âèáèðàþòüñÿ ³ ïåðåðàõîâóþòüñÿ, ÿê ïóíêòè â êóìóëÿòèâíèõ îïèòóâàëüíèõ ëèñòàõ àáî øêàëàõ.
Âåëè÷èíà çì³ííî¿ â³äîáðàæàºòüñÿ çà ïîðÿäêîâèì, ö³ëî÷èñåëüíèì çíà÷åííÿì (òàêîæ çâàí³ «ïåðâèííèìè äàíèìè», íàïð. îö³íêà
íåçàëåæíîñò³, îòðèìàíà çà øêàëîþ Functional Independence Measure). Ïîáóäîâà òà âàë³äàö³ÿ âèì³ðþâàíü ðåçóëüòàò³â º îñíî-
âîþ ìåòîäîëî㳿 äîñë³äæåííÿ ÔÐÌ, íå ìåíø, í³æ á³îìåõàí³÷í³ òà íåéðîô³ç³îëîã³÷í³ ìåòîäè. Öÿ íàóêîâà ñôåðà íàçèâàºòüñÿ ïñè-
õîìåòð³ºþ, ÿêà ïîâ’ÿçàíà ç ¿¿ ïîõîäæåííÿì íà ïî÷àòêó ÕÕ ñòîë³òòÿ ç âèâ÷åííÿ «ïñèõîëîã³÷íèõ» ôåíîìåí³â; îäíàê, ïåðåâàãà ìàº
áóòè íàäàíà òåðì³íó «ïåðñîíàëüí³ ïîêàçíèêè».

Òàáëèöÿ ²Á ï³äñóìîâóº ñïåöèô³êó ñòàòèñòè÷íèõ àíàë³ç³â, ïðèçíà÷åíèõ äëÿ âèì³ðþâàííÿ «ëàòåíòíèõ çì³ííèõ». Öå âëàñòèâîñò³,
«ïðèõîâàí³» â ëþäèí³ (òàê³ ÿê çíàííÿ, ñïðèéíÿòòÿ, çäàòíîñò³, íàñòð³é òîùî), ÿê³ ìîæóòü áóòè âèâåäåí³ ò³ëüêè ç ïîâåä³íêè ïðåä-
ñòàâíèêà. ßê ò³ëüêè ïîòð³áíà çì³ííà º âèçíà÷åíîþ, ïîáóäîâà øêàëè íàáóâຠïð³îðèòåòíîñò³. Ìåòîäè ïîáóäîâè òà âàë³äàö³¿ öèõ
³íñòðóìåíò³â º ñêëàäíèìè ³ âèìàãàþòü íå ò³ëüêè êë³í³÷íèõ ³ ìàòåìàòè÷íèõ íàâè÷îê, àëå é ãëèáîêî¿ ãíîñåîëîã³÷íî¿ ðåôëåêñ³¿ (äëÿ
ñòâîðåííÿ øêàë, ùî â³äîáðàæàþòü ðåàëüí³, ³ñíóþ÷³, õî÷à ³ ïðèõîâàí³, çì³íí³). Êëþ÷îâèì ìîìåíòîì º âàë³äí³ñòü ïåðâèííèõ
äàíèõ, ÿê îö³íîê: ä³éñíî, ïåðâèíí³ äàí³, âèêîðèñòàí³ äëÿ åëåìåíò³â (íàïð. 0 / 1: â³äñóòí³ñòü / íàÿâí³ñòü, 0 / 1 / 2: íåìຠ/ ïîì³ðíî
/ ³íòåíñèâíî òîùî) – öå âñüîãî ëèøå ï³äðàõóíîê ñïîñòåðåæåíü (íàïð. ñê³ëüêè ðàç³â òðàïëÿºòüñÿ ñïîñòåðåæåííÿ 0, í³æ 1 òîùî),
àëå âîíè íå ãîâîðÿòü íàì, àí³ «íàñê³ëüêè á³ëüøå» çíà÷èòü çì³ííà «ïðèñóòí³ñòü» ïîð³âíÿëüíî ç «â³äñóòí³ñòþ», àí³ íàñê³ëüêè
á³ëüøå çì³ííà «ïîì³ðíî» çíà÷èòü ïîð³âíÿëüíî ç «â³äñóòí³é», ³ íàñê³ëüêè «ìåíøå» öå çíà÷èòü ïîð³âíÿëüíî ç «³íòåíñèâíî».
Ïîòð³áíå ñêëàäíå ìàòåìàòè÷íå ìîäåëþâàííÿ (íàïð. àíàë³ç Ðàøà), ãëèáîêî âêëàäåíå â êóëüòóðó ÔÐÌ (85) íå ëèøå â ïàðàäèãìàõ
îñâ³òí³õ òà ñîö³îëîã³÷íèõ äîñë³äæåíü.
ϳñëÿ òîãî, ÿê áóäóòü çðîáëåí³ â³äïîâ³äí³ âèì³ðþâàííÿ íàëåæíèõ çì³ííèõ, ïðèõîäèòü ÷àñ òðàäèö³éíî¿ ñòàòèñòèêè. Ñïðîùóþ÷è
òåìó, ñòàòèñòè÷í³ ìîäåë³ çäåá³ëüøå íàìàãàþòüñÿ â³äïîâ³ñòè íà êðèòè÷íå çàïèòàííÿ: ÷è º ïåâíà ð³çíèöÿ (ì³æ ãðóïàìè, ïåðåä-
ï³ñëÿ ë³êóâàííÿ òîùî) òàêîþ, ùî ñïîñòåð³ãàºòüñÿ ëèøå âèïàäêîâî? Ó çâè÷àéí³é «á³î-ìåäè÷í³é» ñòàòèñòèö³ ð³âåíü äîñòîâ³ðíîñò³
çíà÷èìîñò³ ÷àñòî º ê³íöåâèì êðèòåð³ºì: ÿêùî öÿ ð³çíèöÿ ìîæå ñïîñòåð³ãàòèñÿ âèïàäêîâî çà ìåæàìè äîâ³ëüíîãî â³äñîòêà ïîòåí-
ö³éíèõ ðåïë³êàö³é îäíîãî âèì³ðó (ÿê ïðàâèëî, 5%, òîáòî p = 0,05), ðåçóëüòàòè ââàæàþòüñÿ «íåäîñòîâ³ðíèìè». Öÿ ïàðàäèãìà
â³äõèëåííÿ ã³ïîòåçè Íåéìàíà-ϳðñîíà íàéêðàùå çàñòîñîâóºòüñÿ äî ³íäåêñ³â îñíîâíî¿ òåíäåíö³¿ â ïîïóëÿö³ÿõ (çàçâè÷àé ñåðåäí³õ
çíà÷åíü ³ ìåä³àí) ³ äຠçàõèñò â³ä õèáíî-ïîçèòèâíèõ ðåçóëüòàò³â (òîáòî òèõ, ÿê³ ìîæóòü âèõîäèòè ç ÷èñòî¿ âèïàäêîâîñò³). Àëå, ïî-
ïåðøå, ç³ çá³ëüøåííÿì ÷èñëà ñïîñòåðåæåíü ðåàëüíèé çàõèñò â³ä õèáíîïîçèòèâíèõ ðåçóëüòàò³â ïàðàäîêñàëüíî çìåíøóºòüñÿ: ó
âåëèêèõ âèá³ðêàõ íåðåëåâàíòí³ â³äì³ííîñò³ ìîæóòü ëåãêî ñòàòè ñòàòèñòè÷íî «äîñòîâ³ðíèìè», íåçâàæàþ÷è íà òå, ùî âîíè º ìàð-
ã³íàëüíèìè àáî ìàðíèìè â êë³í³÷í³é ïðàêòèö³. Ïî-äðóãå, ÷èì á³ëüøå âè çàõèùåí³ (ùî ñòîñóºòüñÿ íåâåëèêèõ çðàçê³â), òî á³ëüøå
ñïðàâæí³õ ïîçèòèâíèõ ðåçóëüòàò³â áóäå òàêîæ â³äõèëåíî. Òîìó çðîñòàþ÷èé ³íòåðåñ ìîæå ñïîñòåð³ãàòèñÿ äëÿ îö³íêè «ïîòóæ-
íîñò³» (éìîâ³ðí³ñòü âèÿâëåííÿ ñïðàâæí³õ ïîçèòèâíèõ ðåçóëüòàò³â) ³ «ðîçì³ðó» âèá³ðêè, ³ â ê³íöåâîìó ï³äñóìêó, êë³í³÷íî¿ «âàæ-
ëèâîñò³» åôåêò³â ðàçîì ç ¿õ ð- áàçîâàíîþ äîñòîâ³ðí³ñòþ (Òàáë. ²Á).
Ó òîé æå ÷àñ äîñòóïí³ ³íø³ ñêëàäí³ ñòàòèñòè÷í³ ï³äõîäè, ³ ¿õ âèêîðèñòàííÿ çðîñòຠâ ë³òåðàòóð³ ç ÔÐÌ, ç òèì, ùîá çðîçóì³òè
çì³íè ó îêðåìèõ îñ³á (à íå ò³ëüêè â ïîïóëÿö³ÿõ). Ïðèêëàäîì º ïîøóê äëÿ: à) «ì³í³ìàëüíî¿ çì³íè, ùî âèÿâëÿºòüñÿ» (ÌÇÂ, òàêîæ
íàçèâàºòüñÿ «ì³í³ìàëüíà ðåàëüíà ð³çíèöÿ»), òîáòî íàéìåíøà çì³íà (íàïð. äî òà ï³ñëÿ ë³êóâàííÿ), ÿêà, éìîâ³ðíî, â³äîáðàæàº
ñïðàâæíþ çì³íó, à íå ò³ëüêè ïîìèëêó âèì³ðþâàííÿ â îêðåìèõ îñ³á. Éîãî çíà÷åííÿ ïîâ’ÿçàíî ç ³íäåêñàìè â³äòâîðþâàíîñò³ ³
ñòàòèñòè÷íèìè ìîäåëÿìè íà îñíîâ³ ðîçïîä³ëó; ³ á) «ì³í³ìàëüíà êë³í³÷íî âàæëèâà â³äì³íí³ñòü» (ÌÊÂÂ), ùî ïðåäñòàâëÿº íàéìåí-
øó çì³íó âèì³ðþâàííÿ, ÿêà ïîâèííà ââàæàòèñÿ çíà÷èìîþ â³äïîâ³äíî äî êë³í³÷íèõ êðèòåð³¿â (ïîâ’ÿçàíå ³ç çîâí³øí³ì ñóäæåí-
íÿì, ùî ìຠíà óâàç³ ñòàòèñòè÷í³ ìîäåë³ íà îñíîâ³ ïðèâ’ÿçêè) ³ ìຠáóòè åêâ³âàëåíòíèì àáî âèùå í³æ MÇÂ.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 185
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Ɍɚɛɥɢɰɹ ȱȼ ɿɥɸɫɬɪɭɽ ɬɪɟɬɽ ɬɚ ɨɫɬɚɧɧɽ ɩɪɚɜɢɥɨ ɝɪɢ, ɹɤɟ ɫɥɿɞ ɪɨɡɝɥɹɧɭɬɢ, ɬɨɛɬɨ ɞɢɡɚɣɧ ɞɨɫɥɿɞɠɟɧɧɹ. Ɂɧɨɜɭ ɫɩɪɨɳɭɸɱɢ ɰɸ
ɧɚɭɤɨɜɭ ɬɟɦɚɬɢɤɭ, ɦɨɠɧɚ ɫɬɜɟɪɞɠɭɜɚɬɢ, ɳɨ ɞɢɡɚɣɧ ɞɨɫɥɿɞɠɟɧɧɹ ɦɚɽ ɡɚ ɦɟɬɭ ɨɰɿɧɢɬɢ ɫɢɥɭ ɩɪɢɱɢɧɧɨ-ɧɚɫɥɿɞɤɨɜɢɯ ɡɜ’ɹɡɤɿɜ
ɦɿɠ ɥɿɤɭɜɚɧɧɹɦ ɬɚ ɪɟɡɭɥɶɬɚɬɨɦ. ɑɢɦ ɛɿɥɶɲɟ ɽ ɫɬɿɣɤɿɫɬɶ ɩɪɢɱɢɧɧɨɝɨ ɜɢɫɧɨɜɤɭ, ɬɢɦ ɛɿɥɶɲɟ ɦɨɠɥɢɜɨ ɝɨɜɨɪɢɬɢ, ɳɨ ɪɟɡɭɥɶɬɚɬ,
ɹɤɢɣ ɫɩɨɫɬɟɪɿɝɚɽɬɶɫɹ, ɦɨɠɟ ɜɜɚɠɚɬɢɫɹ ɞɿɣɫɧɢɦ ɪɟɡɭɥɶɬɚɬɨɦ. ɋɬɚɬɢɫɬɢɤɚ ɩɨɤɚɡɭɽ, ɱɢ ɧɟ ɽ ɪɟɡɭɥɶɬɚɬ ɜɢɩɚɞɤɨɜɢɦ; ɞɢɡɚɣɧ
ɞɨɫɥɿɞɠɟɧɧɹ ɩɿɞɬɪɢɦɭɽ ɜɚɲɟ ɬɜɟɪɞɠɟɧɧɹ, ɳɨ ɩɪɢɱɢɧɨɸ ɽ ɬɟ, ɳɨ ɜɢ ɜɜɚɠɚɽɬɟ. ȱɧɲɢɦɢ ɫɥɨɜɚɦɢ, ɞɢɡɚɣɧ ɞɨɫɥɿɞɠɟɧɧɹ ɩɪɚɝɧɟ
ɜɢɪɿɲɢɬɢ ɧɟɦɢɧɭɱɭ «ɩɪɨɛɥɟɦɭ ɩɨɹɫɧɟɧɧɹ ɬɪɟɬɶɨʀ ɡɦɿɧɧɨʀ» (ɬɢɩ ɡɦɿɲɭɜɚɧɧɹ, ɜ ɹɤɨɦɭ «ɬɪɟɬɹ» ɡɦɿɧɧɚ – ɮɚɤɬɢɱɧɨ, ɨɞɧɚ, ɚɛɨ
ɤɿɥɶɤɚ ɿɧɲɢɯ, ɱɚɫɬɨ, ɧɟɩɟɪɟɞɛɚɱɟɧɨɸ – ɩɪɢɡɜɨɞɢɬɶ ɞɨ ɩɨɦɢɥɤɨɜɨɝɨ ɩɪɢɱɢɧɧɨɝɨ ɡɜ’ɹɡɤɭ ɦɿɠ ɞɜɨɦɚ ɿɧɲɢɦɢ). Ⱦɥɹ ɩɪɨɰɟɞɭɪ
ɞɨɫɥɿɞɠɟɧɧɹ ɦɨɠɭɬɶ ɛɭɬɢ ɡɚɫɬɨɫɨɜɚɧɿ ɪɿɡɧɿ ɮɨɪɦɢ ɤɨɧɬɪɨɥɸ, ɳɨɛ ɦɿɧɿɦɿɡɭɜɚɬɢ ɪɨɥɶ «ɬɪɟɬɶɨʀ ɡɦɿɧɧɨʀ»; ɚɪɯɟɬɢɩ ɰɢɯ
ɩɪɨɰɟɞɭɪ – ɰɟ ɪɚɧɞɨɦɿɡɨɜɚɧɟ ɩɨɞɜɿɣɧɟ ɫɥɿɩɟ ɤɨɧɬɪɨɥɶɨɜɚɧɟ ɞɨɫɥɿɞɠɟɧɧɹ (ɊɄȾ). ɐɹ ɩɪɚɤɬɢɤɚ ɽ ɤɨɪɢɫɧɨɸ, ɧɟɨɛɯɿɞɧɨɸ ɬɚ
ɪɟɚɥɶɧɨɸ ɜ ɞɟɹɤɢɯ ɨɛɥɚɫɬɹɯ ɎɊɆ. Ⱥɥɟ, ɹɤ ɩɨɤɚɡɭɽ ɬɚɛɥ. ȱȼ, ɡ ɛɚɝɚɬɶɨɯ ɩɪɢɱɢɧ ɬɚɤɿ ɞɢɡɚɣɧɢ ɦɨɠɭɬɶ ɛɭɬɢ ɧɟɩɪɚɤɬɢɱɧɢɦɢ
ɩɪɢ ɩɪɨɜɟɞɟɧɧɿ ɩɨɜɟɞɿɧɤɨɜɢɯ ɞɨɫɥɿɞɠɟɧɶ. ɑɚɫɬɨ ɩɨɽɞɧɚɧɧɹ ɟɤɫɩɟɪɢɦɟɧɬɚɥɶɧɢɯ, ɧɟ ɟɤɫɩɟɪɢɦɟɧɬɚɥɶɧɢɯ ɬɚ ɹɤɿɫɧɢɯ ɞɢɡɚɣɧɿɜ
ɦɨɠɟ ɡɚɛɟɡɩɟɱɢɬɢ ɧɚɭɤɨɜɨ ɨɛʉɪɭɧɬɨɜɚɧɢɣ ɚɧɚɥɿɡ ɟɮɟɤɬɢɜɧɨɫɬɿ ɜ ɪɟɚɛɿɥɿɬɚɰɿʀ. ɇɚɩɪɢɤɥɚɞ, ɞɨɫɬɭɩɧɿ ɜɞɨɫɤɨɧɚɥɟɧɿ «ɤɜɚɡɿ-
ɟɤɫɩɟɪɢɦɟɧɬɚɥɶɧɿ» ɩɚɪɚɞɢɝɦɢ ɞɨɫɥɿɞɠɟɧɶ ɩɨɯɨɞɹɬɶ ɡ ɩɫɢɯɨɥɨɝɿɱɧɢɯ ɿ ɫɨɰɿɚɥɶɧɢɯ ɞɨɫɥɿɞɠɟɧɶ (86), ɜɤɥɸɱɚɸɱɢ ɞɢɡɚɣɧɢ
ɨɞɧɨɝɨ ɜɢɩɚɞɤɭ, ɞɨɫɥɿɞɧɢɰɶɤɿ ɞɢɡɚɣɧɢ ɱɚɫɨɜɢɯ ɪɹɞɿɜ, ɞɢɡɚɣɧɢ Small-N ɬɚ ɿɧɲɿ ɫɩɟɰɿɚɥɶɧɿ ɫɩɨɫɬɟɪɟɠɧɿ ɞɢɡɚɣɧɢ (ɧɚɩɪ. ɬɚɤ
ɡɜɚɧɿ ɞɢɡɚɣɧɢ ɞɨɫɥɿɞɠɟɧɶ ɞɨɤɚɡɿɜ ɧɚ ɨɫɧɨɜɿ ɩɪɚɤɬɢɤɢ) (87). ɐɿ ɞɢɡɚɣɧɢ ɦɨɠɭɬɶ ɩɪɟɞɫɬɚɜɥɹɬɢ ɫɨɛɨɸ ɩɪɚɜɢɥɶɧɟ ɪɿɲɟɧɧɹ ɞɥɹ
ɞɨɫɥɿɞɧɢɰɶɤɢɯ ɩɢɬɚɧɶ, ɹɤɿ ɧɟ ɦɨɠɭɬɶ ɛɭɬɢ ɪɨɡɬɹɝɧɭɬɿ ɡɚ ɞɨɜɿɥɶɧɢɦ ɫɬɚɧɞɚɪɬɨɦ, ɞɨ ɹɤɨɝɨ ɩɪɢɦɭɲɭɽɬɶɫɹ ɬɨɱɧɚ ɜɿɞɩɨɜɿɞɧɿɫɬɶ
(ɹɤ ɭ ɦɿɮɿ ɩɪɨ ɩɪɨɤɪɭɫɬɨɜɟ ɥɿɠɤɨ), ɧɚɩɪ. ɞɢɡɚɣɧɢ ɊɄȾ. Ɂɜɢɱɚɣɧɨ, ɫɢɫɬɟɦɚɬɢɱɧɿ ɨɝɥɹɞɢ ɬɚ ɩɨɜ’ɹɡɚɧɿ ɡ ɧɢɦɢ ɦɟɬɨɞɢ ɫɤɥɚɞɚɧɧɹ
ɩɪɚɤɬɢɱɧɢɯ ɪɟɤɨɦɟɧɞɚɰɿɣ ɦɚɸɬɶ ɛɭɬɢ ɛɿɥɶɲ ɱɭɬɥɢɜɢɦɢ ɞɨ ɞɨɤɚɡɿɜ, ɹɤɿ ɧɟ ɽ ɪɟɡɭɥɶɬɚɬɚɦɢ ɊɄȾ, ɞɥɹ ɬɨɝɨ, ɳɨɛ ɞɿɣɫɧɨ
ɜɢɡɧɚɱɢɬɢ ɿ ɩɪɚɜɢɥɶɧɨ ɨɰɿɧɸɜɚɬɢ ɧɚɣɤɪɚɳɿ ɞɨɤɚɡɢ ɞɥɹ ɤɥɿɧɿɱɧɨʀ ɩɪɚɤɬɢɤɢ (82, 88). ɇɚɩɪɢɤɥɚɞ, ɞɨɛɪɟ ɩɪɨɜɟɞɟɧɿ ɤɨɝɨɪɬɧɿ,
ɤɨɪɟɥɹɰɿɣɧɿ ɚɛɨ ɩɨɪɿɜɧɹɥɶɧɿ ɞɨɫɥɿɞɠɟɧɧɹ ɦɨɠɭɬɶ ɞɚɜɚɬɢ ɿɧɮɨɪɦɚɰɿɸ, ɹɤɚ ɛɿɥɶɲ ɡɚɫɬɨɫɨɜɧɚ ɞɥɹ ɩɪɚɤɬɢɤɢ, ɧɿɠ ɩɨɹɫɧɸɜɚɥɶɧɿ
ɊɄȾ ɡ ɜɭɡɶɤɢɦɢ ɤɪɢɬɟɪɿɹɦɢ ɜɤɥɸɱɟɧɧɹ.
Ʉɥɿɧɿɱɧɚ ɦɟɞɢɰɢɧɚ (ɜɤɥɸɱɧɨ ɿɡ ɎɊɆ) Ȼɿɨɦɟɞɢɰɢɧɚ
ɚ) ɡɦɿɧɧɿ
ɉɨɜɟɞɿɧɤɨɜɿ; ɜɥɚɫɬɢɜɨɫɬɿ ɥɸɞɢɧɢ ɜ ɰɿɥɨɦɭ (ɧɚɩɪ. ɧɟɡɚɥɟɠɧɿɫɬɶ, ɜɬɨɦɚ, ȼɥɚɫɬɢɜɨɫɬɿ ɱɚɫɬɢɧ ɥɸɞɢɧɢ (ɧɚɩɪ. ɬɟɦɩɟɪɚɬɭɪɚ
ɛɿɥɶ, ɪɿɜɧɨɜɚɝɚ, ɫɩɿɥɤɭɜɚɧɧɹ ɬɨɳɨ); ɱɚɫɬɨ ɨɩɢɫɭɸɬɶɫɹ ɩɭɧɤɬɚɦɢ ɲɤɿɪɢ, ɚɪɬɟɪɿɚɥɶɧɢɣ ɬɢɫɤ, ɲɜɢɞɤɿɫɬɶ ɩɪɨɜɿɞɧɨɫɬɿ
ɨɩɢɬɭɜɚɥɶɧɢɤɿɜ, ɨɰɿɧɸɸɬɶɫɹ ɫɩɨɫɬɟɪɿɝɚɱɟɦ (ɿɧɨɞɿ ɫɚɦɢɦ ɫɭɛ’ɽɤɬɨɦ). ɩɨ ɧɟɪɜɚɯ, ɚɧɚɥɿɡɢ ɤɪɨɜɿ, ɤɨɦɩ’ɸɬɟɪɧɚ ɬɨɦɨɝɪɚɮɿɹ
«Ʌɚɬɟɧɬɧɿ». Ɇɨɠɭɬɶ ɫɩɨɫɬɟɪɿɝɚɬɢɫɶ ɧɟ ɰɿɥɤɨɦ ɚɛɨ ɛɟɡɩɨɫɟɪɟɞɧɶɨ. Ȳɯ ɬɨɳɨ).
ɤɿɥɶɤɿɫɬɶ ɦɨɠɟ ɛɭɬɢ ɜɢɜɟɞɟɧɚ ɬɿɥɶɤɢ ɡ ɩɨɤɚɡɧɢɤɿɜ ɩɿɞɪɚɯɭɧɤɿɜ «Ɇɚɧɿɮɟɫɬɧɿ»: ʀɯ ɤɿɥɶɤɿɫɬɶ ɰɿɥɤɨɦ ɜɿɞɤɪɢɬɚ ɞɥɹ
ɩɨɜɟɞɿɧɤɢ, ɳɨ ɩɪɟɞɫɬɚɜɥɹɸɬɶ ɜɥɚɫɬɢɜɿɫɬɶ ɫɭɛ’ɽɤɬɚ (ɧɚɩɪ. ɩɿɞɪɚɯɭɧɨɤ ɫɩɨɫɬɟɪɟɠɟɧɧɹ.
ɜɿɞɩɨɜɿɞɟɣ ɨɩɢɬɭɜɚɥɶɧɢɤɚ ɦɨɠɟ ɜɤɚɡɭɜɚɬɢ ɛɿɥɶɲ-ɦɟɧɲ ɧɚ ɧɟɡɚɥɟɠɧɿɫɬɶ Ȼɟɡɩɟɪɟɪɜɧɿ, ɥɿɧɿɣɧɿ ɜɢɦɿɪɸɜɚɧɧɹ. ȼɢɫɨɤɚ ɬɨɱɧɿɫɬɶ
ɭ ɩɨɜɫɹɤɞɟɧɧɨɦɭ ɠɢɬɬɿ, ɜɬɨɦɭ, ɛɿɥɶ ɬɨɳɨ). ɿ ɧɚɞɿɣɧɿɫɬɶ ɡɚɜɞɹɤɢ ɿɧɫɬɪɭɦɟɧɬɚɥɶɧɢɦ ɜɢɦɿɪɚɦ.
«ȼɢɦɿɪɸɜɚɧɧɹ» ɽ ɩɨɪɹɞɤɨɜɢɦɢ, ɞɢɫɤɪɟɬɧɢɦɢ (ɩɿɞɪɚɯɭɧɤɢ ɩɨɞɿɣ).
Ʉɨɠɧɚ ɜɿɞɩɨɜɿɞɶ ɦɨɠɟ ɜɜɚɠɚɬɢɫɹ «ɳɟ ɨɞɧɿɽɸ», ɚɥɟ ʀʀ «ɜɚɝɚ» ɽ
ɧɟɜɿɞɨɦɨɸ. ɋɟɪɣɨɡɧɿ ɧɟɥɿɧɿɣɧɨɫɬɿ ɬɚ ɩɨɦɢɥɤɢ ɜɩɥɢɜɚɸɬɶ ɧɚ ɫɭɦɢ
ɩɿɞɪɚɯɭɧɤɿɜ, ɳɨ ɜɪɚɯɨɜɭɸɬɶɫɹ, ɹɤ ɩɪɟɞɫɬɚɜɧɢɤɢ ɪɟɚɥɶɧɨʀ «ɤɿɥɶɤɨɫɬɿ».
ɛ) ɋɬɚɬɢɫɬɢɤɚ
Ⱦɥɹ ɨɰɿɧɤɢ ɥɿɧɿɣɧɢɯ ɡɚɯɨɞɿɜ ɿ ɩɨɦɢɥɨɤ ɩɟɪɜɢɧɧɢɯ ɞɚɧɢɯ ɧɟɨɛɯɿɞɧɿ Ɉɞɢɧɢɰɿ ɜɢɦɿɪɭ ɦɚɸɬɶ ɡɚɡɧɚɱɟɧɭ ɜɚɥɿɞɧɿɫɬɶ (ɧɚɩɪ.
ɫɬɚɬɢɫɬɢɱɧɿ ɦɨɞɟɥɿ (ɧɚɩɪ. ɚɧɚɥɿɡ Ɋɚɲ). ɨɞɢɧɢɰɿ ɞɨɜɠɢɧɢ, ɜɚɝɢ, ɧɚɩɪɭɝɢ, ɱɚɫɭ).
ɍɧɿɤɚɥɶɧɿɫɬɶ ɥɸɞɢɧɢ. ɍɫɟɪɟɞɧɟɧɧɹ ɦɨɠɟ ɛɭɬɢ ɫɭɦɧɿɜɧɢɦ. ɉɨɯɢɛɤɚ ɋɟɪɟɞɧɿ ɿ ɦɟɞɿɚɧɢ ɨɬɨɱɟɧɿ ɩɨɯɢɛɤɚɦɢ ɦɟɧɲɢɦɢ,
ɿɧɞɢɜɿɞɭɚɥɶɧɨɝɨ ɜɢɦɿɪɭ ɧɟ ɦɨɠɟ ɜɜɚɠɚɬɢɫɹ ɪɿɜɧɨɸ ɩɨɯɢɛɰɿ ɨɰɿɧɰɿ ɧɿɠ ɨɤɪɟɦɿ ɜɢɦɿɪɸɜɚɧɧɹ. ȼɢɫɧɨɜɤɢ ɦɨɠɭɬɶ ɛɭɬɢ
ɫɟɪɟɞɧɶɨʀ. ɡɪɨɛɥɟɧɿ ɧɚ ɨɫɧɨɜɿ ɜɫɬɚɧɨɜɥɟɧɢɯ ɩɚɪɚɦɟɬɪɿɜ (ɧɚɩɪ.
ȱɧɞɢɜɿɞɭɚɥɶɧɿ ɨɫɨɛɥɢɜɨɫɬɿ ɽ ɫɭɬɬɽɜɢɦɢ (ɧɚɩɪ. ɩɪɢ ɩɪɢɣɧɹɬɬɿ ɪɿɲɟɧɧɹ ɧɨɪɦɚɥɶɧɨɝɨ ɪɨɡɩɨɞɿɥɭ, ɞɨɜɿɪɱɢɯ ɿɧɬɟɪɜɚɥɿɜ
ɩɪɨ ɥɿɤɭɜɚɧɧɹ). ɬɨɳɨ).
Ɋɟɡɭɥɶɬɚɬɨɦ ɱɚɫɬɨ ɽ ɩɟɪɟɪɜɚɧɿ ɩɨɞɿʀ (ɧɚɩɪ. ɩɨɜɟɪɧɟɧɧɹ ɞɨ ɪɨɛɨɬɢ, Ɋɟɡɭɥɶɬɚɬɢ ɡɚɡɜɢɱɚɣ ɽ ɛɟɡɩɟɪɟɪɜɧɢɦɢ ɚɛɨ
ɜɢɩɢɫɤɚ ɞɨɞɨɦɭ ɬɨɳɨ). ɞɢɫɤɪɟɬɧɢɦɢ (ɩɿɞɪɚɯɭɧɤɢ). ȼɫɬɚɧɨɜɥɟɧɿ ɦɨɞɟɥɿ,
Ʌɨɝɿɫɬɢɱɧɚ ɪɟɝɪɟɫɿɹ ɬɚ ɦɨɞɟɥɸɜɚɧɧɹ ɧɚ ɨɫɧɨɜɿ ɜɡɚɽɦɨɞɿʀ (ɧɚɩɪ. ɚɧɚɥɿɡ ɡɚɫɬɨɫɨɜɧɿ ɞɨ ɫɟɪɟɞɧɿɯ, ɦɨɠɭɬɶ ɡɚɫɬɨɫɨɜɭɜɚɬɢɫɹ ɞɨ
ɜɢɠɢɜɚɧɧɹ, ɧɟɣɪɨɧɧɿ ɦɟɪɟɠɿ, ɞɟɪɟɜɚ ɤɥɚɫɢɮɿɤɚɰɿʀ ɬɚ ɪɟɝɪɟɫɿʀ) ɽ ɛɿɥɶɲ ɩɪɢɩɭɳɟɧɶ (ɧɚɩɪ. ANOVA, ɦɧɨɠɢɧɧɚ ɪɟɝɪɟɫɿɹ)
ɞɨɰɿɥɶɧɢɦɢ, ɧɿɠ ɡɜɢɱɚɣɧɿ ɫɬɚɬɢɫɬɢɱɧɿ ɞɚɧɿ ANOVA ɚɛɨ ɪɟɝɪɟɫɿʀ, ɿ ɿɞɟɧɬɢɮɿɤɚɰɿʀ «ɥɚɬɟɧɬɧɢɯ» ɡɦɿɧɧɢɯ (ɧɚɩɪ.
ɡɚɫɧɨɜɚɧɿ ɧɚ «ɨɫɧɨɜɧɢɯ» ɟɮɟɤɬɚɯ ɫɟɪɟɞɧɿɯ. ɩɪɨɰɟɞɭɪɢ ɚɧɚɥɿɡɭ ɮɚɤɬɨɪɿɜ).
ȿɮɟɤɬɢ ɪɨɡɦɿɪɿɜ ɩɨɦɿɪɧɿ, ɪɨɡɦɿɪɢ ɜɢɛɿɪɤɢ ɧɟɜɟɥɢɤɿ, ɩɨɛɿɱɧɿ ɟɮɟɤɬɢ Ɋɨɡɦɿɪɢ ɟɮɟɤɬɿɜ ɩɨɬɟɧɰɿɣɧɨ ɜɟɥɢɤɿ. ɉɨɛɿɱɧɿ
ɩɨɦɿɪɧɿ. ɋɬɚɬɢɫɬɢɤɚ ɩɨɜɢɧɧɚ ɬɚɤɨɠ ɜɤɚɡɭɜɚɬɢ ɧɚ ɫɢɥɭ (ɩɿɞɜɢɳɟɧɧɹ ɟɮɟɤɬɢ ɩɨɬɟɧɰɿɣɧɨ ɲɤɿɞɥɢɜɿ. Ɂɚɯɢɫɬ ɜɿɞ ɯɢɛɧɨ-
ɿɫɬɢɧɧɨɝɨ ɩɨɡɢɬɢɜɧɨɝɨ ɪɢɡɢɤɭ). Ⱦɨɫɬɨɜɿɪɧɿɫɬɶ ɩɪɨɫɬɨ ɡɚɩɨɛɿɝɚɽ ɯɢɛɧɨ- ɩɨɡɢɬɢɜɧɢɯ ɪɟɡɭɥɶɬɚɬɿɜ (ɞɨɫɬɨɜɿɪɧɿɫɬɶ) ɡɚɡɜɢɱɚɣ
ɩɨɡɢɬɢɜɧɢɦ ɜɢɫɧɨɜɤɚɦ, ɚɥɟ ɦɨɠɟ ɩɪɢɯɨɜɭɜɚɬɢ ɫɩɪɚɜɠɧɿ ɩɨɡɢɬɢɜɧɿ ɦɚɽ ɩɪɿɨɪɢɬɟɬ.
ɜɢɫɧɨɜɤɢ ɧɟ ɦɟɧɲ, ɧɿɠ ɞɨɫɬɨɜɿɪɧɿɫɬɶ. Ɋɟɡɭɥɶɬɚɬɢ ɜ ɨɫɧɨɜɧɨɦɭ ɞɚɸɬɶɫɹ, ɹɤ ɡɦɿɧɢ ɧɚ
ɇɟɨɛɯɿɞɧɨ ɨɰɿɧɢɬɢ ɜɧɭɬɪɿɲɧɸ ɬɨɱɧɿɫɬɶ ɿɧɫɬɪɭɦɟɧɬɭ ɞɥɹ ɨɰɿɧɤɢ ɫɭɤɭɩɧɨɦɭ, ɚ ɧɟ ɧɚ ɿɧɞɢɜɿɞɭɚɥɶɧɨɦɭ ɪɿɜɧɿ.
ɿɧɞɢɜɿɞɭɚɥɶɧɢɯ ɡɦɿɧ (ɦɿɧɿɦɚɥɶɧɚ ɡɦɿɧɚ, ɳɨ ɜɢɹɜɥɹɽɬɶɫɹ; ɦɿɧɿɦɚɥɶɧɚ
ɤɥɿɧɿɱɧɨ ɜɚɠɥɢɜɚ ɜɿɞɦɿɧɧɿɫɬɶ).
ɜ) Ⱦɢɡɚɣɧ ɞɨɫɥɿɞɠɟɧɧɹ
ȼɡɚɽɦɨɞɿɸ ɩɚɰɿɽɧɬɚ ɿ ɤɥɿɧɿɰɢɫɬɚ ɱɚɫɬɨ ɫɥɿɞ ɪɨɡɝɥɹɞɚɬɢ, ɹɤ ɞɠɟɪɟɥɨ Ɉɫɧɨɜɧɚ ɭɜɚɝɚ ɜ ɞɨɫɥɿɞɠɟɧɧɿ ɩɪɢɞɿɥɹɽɬɶɫɹ
ɟɮɟɤɬɢɜɧɨɫɬɿ, ɚ ɧɟ ɩɨɯɢɛɤɢ ɜɢɦɿɪɸɜɚɧɧɹ. ȿɮɟɤɬɢɜɧɚ ɪɚɧɞɨɦɿɡɚɰɿɹ ɬɚ ɫɟɪɟɞɧɿɦ / ɦɟɞɿɚɧɚɦ. Ɂɚɡɜɢɱɚɣ ɡɚɫɬɨɫɨɜɭɽɬɶɫɹ
ɡɚɫɥɿɩɥɟɧɧɹ ɧɟ ɡɚɜɠɞɢ ɡɚɫɬɨɫɨɜɧɿ. ɑɚɫɬɨ ɽ ɧɟɨɛɯɿɞɧɢɦɢ ɤɜɚɡɿ- ɤɨɧɬɪɨɥɶ ɪɚɧɞɨɦɿɡɚɰɿɽɸ ɬɚ ɡɚɫɥɿɩɥɟɧɧɹɦ.
ɟɤɫɩɟɪɢɦɟɧɬɚɥɶɧɿ ɞɢɡɚɣɧɢ. Ɂɚɡɜɢɱɚɣ ɡɚɫɬɨɫɨɜɭɸɬɶɫɹ ɨɞɧɨɤɨɦɩɨɧɟɧɬɧɿ,
Ɉɞɧɨɤɨɦɩɨɧɟɧɬɧɿ, ɥɿɤɭɜɚɧɧɹ ɡɿ ɫɬɚɧɞɚɪɬɧɢɦ ɞɨɡɭɜɚɧɧɹɦ ɪɿɞɤɨ ɫɬɚɧɞɚɪɬɧɿ ɞɨɡɢ ɥɿɤɭɜɚɧɧɹ.
ɡɚɫɬɨɫɨɜɭɸɬɶɫɹ. Ȼɿɥɶɲɟ ɬɚ ɪɿɡɧɢɯ ɥɿɤɭɜɚɧɶ ɩɪɢɡɧɚɱɚɸɬɶɫɹ ɨɤɪɟɦɢɦ
ɿɧɞɢɜɿɞɭɭɦɚɦ. ɉɨɜɢɧɧɿ ɛɭɬɢ ɪɨɡɪɨɛɥɟɧɿ ɫɬɚɧɞɚɪɬɧɿ ɞɟɪɟɜɚ ɩɪɢɣɧɹɬɬɹ
ɪɿɲɟɧɶ (ɩɪɨɝɪɚɦɢ), ɚ ɧɿ ɫɬɚɧɞɚɪɬɧɿ ɦɟɬɨɞɢ ɥɿɤɭɜɚɧɧɹ.

186 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 10 – ÍÀÓÊÀ ÒÀ ÄÎÑ˲ÄÆÅÍÍß Ó ÔÐÌ: ÎÑÎÁËÈÂÎÑÒ² ÒÀ ÏÐÎÁËÅÌÈ
á³ë³òàö³éíî¿ ìåäèöèíè. Ìè íåùîäàâíî îòðèìàëè
äåê³ëüêà òàêèõ ïðèêëàä³â ç³ Øâåö³¿103,104.
Ïðîòå, æèòòºâî âàæëèâèì äëÿ äîñë³äíèöüêî¿
ï³äãîòîâêè â ÔÐÌ º ðîçâèòîê àêàäåì³÷íèõ öåíòð³â
ç äîñòàòíüîþ ñò³éê³ñòþ ³ êðèòè÷íîþ ìàñîþ, ùîá
äîçâîëèòè ïðîäîâæåííÿ áåçïåðåðâíîãî òà ÿñêðà-
âîãî íàóêîâîãî ä³àëîãó òà ïðîäóêö³¿. Ö³ öåíòðè
ïîâèíí³ ì³ñòèòè ê³ëüêà ïîñò³éíèõ äîñë³äíèöüêèõ
ïîñàä, íåîáõ³äí³ ëàáîðàòîðí³ ôóíêö³¿ òà òåõí³÷íèé
ïåðñîíàë. Âîíè çàâæäè ïîâèíí³ áóòè ïîâ’ÿçàí³ ç
êë³í³÷íèì â³ää³ëåííÿì äëÿ ñïðèÿííÿ âçàºìî䳿 ì³æ
ïðàêòèêîþ òà äîñë³äæåííÿìè òà óìîæëèâëåííÿ
òðàíñëÿö³éíèõ äîñë³äæåíü.  òåïåð³øí³é ÷àñ â
ªâðîï³ ðîçïîä³ë àêàäåì³÷íèõ ïîñàä â ÔÐÌ º äóæå
íåîäíîð³äíèì, âðàõîâóþ÷è, ùî 47 òà 46 êàôåäð
ÔÐÌ ìîæíà â³äïîâ³äíî çíàéòè ó Ôðàíö³¿ 105 òà
²òà볿106, ïðîòè îäí³º¿ â ͳìå÷÷èí³, ³ ò³ëüêè äåê³ëü-
êîõ â Âåëèêèé Áðèòàí³¿.
Çíèæåííÿ àêàäåì³÷íîãî ïîòåíö³àëó ÔÐÌ ðàçîì
ç³ ñêîðî÷åííÿì äîñë³äíèöüêîãî ïåðñîíàëó, îáëàä-
íàííÿ, ïðèì³ùåíü òà òåõí³÷íî¿ ï³äòðèìêè â áàãà-
òüîõ äåðæàâíèõ àêàäåì³÷íèõ çàêëàäàõ, âèêëèêàíå
ô³íàíñîâîþ êðèçîþ â ºâðîïåéñüêèõ êðà¿íàõ, ïðåä-
ñòàâëÿº äóæå ñåðéîçíó çàãðîçó äëÿ çàáåçïå÷åííÿ
àäåêâàòíî¿ îñâ³òè ³ íàâ÷àííÿ ñïåö³àë³ñò³â ÔÐÌ, à
òàêîæ äëÿ ïðîñóâàííÿ äîñë³äæåíü â îáëàñò³ ðåàá³-
ë³òàö³¿ ³ äîêàçîâî¿ ïðàêòèêè. Àêàäåì³÷í³ óñòàíîâè
òà, á³ëüø òîãî, îðãàí³çàö³¿ îõîðîíè çäîðîâ’ÿ òà íà-
ö³îíàëüí³ ô³íàíñîâ³ àãåíö³¿ ïîâèíí³ ³íâåñòóâàòè ó
ñòâîðåííÿ íîâèõ ðåàá³ë³òàö³éíèõ äîñë³äíèöüêèõ
ïðîãðàì, àáî ïîñèëåííÿ ³ñíóþ÷èõ, óñâ³äîìëþþ÷è
ãîëîâíó ðîëü, ÿêó â³ä³ãðຠðåàá³ë³òàö³ÿ äëÿ ãëîáàëü-
íîãî ïîêðàùåííÿ çäîðîâ’ÿ íàñåëåííÿ â ºâðîïåé-
ñüêîìó ñóñï³ëüñòâ³, ÿêå, çà ñòâåðäæóºòüñÿ, º ³íêëþ-
çèâíèì, ³ííîâàö³éíèì ³ ðåôëåêñèâíèì107.
Ñüîãîäí³ ÷àñòèíè ³íôðàñòðóêòóðè, íåîáõ³äíî¿
äëÿ äîñë³äæåíü, òàê³, ÿê äîñòóï äî íàóêîâî¿ á³áë³î-
òåêè òà äî á³ëüøîñò³ íàóêîâèõ æóðíàë³â, ìîæóòü
áóòè âèð³øåí³ øëÿõîì êîíòàêòó ÷åðåç ²íòåðíåò.
Òàêîæ íåîáõ³äíèì º ïðîâåäåííÿ ðåãóëÿðíèõ äèñ-
êóñ³é ç äîñâ³ä÷åíèìè ñóïåðâ³çîðàìè, ³ öå òàêîæ
ìîæå â³äáóâàòèñÿ, ïðèíàéìí³ ÷àñòêîâî, ÷åðåç
²íòåðíåò. Öå îçíà÷àº, ùî ìîæëèâèì º, ÿê áóëî
çðîáëåíî â Äàí³¿, ïðîâåäåííÿ äîñë³äæåíü ç ðåàá³-
ë³òàö³¿ “íàä ïîâåðõíåþ” êðà¿íè, à í³ â îäíîìó
öåíòð³108. Òàê³ îðãàí³çàö³¿ ìîæóòü òàêîæ ìàòè ïå-
ðåâàãó ñïðîùåíîãî äîçâîëó äëÿ áàãàòîöåíòðîâèõ
äîñë³äæåíü ÷åðåç ñêëàäí³ñòü íàáîðó âåëèêèõ îä-
íîð³äíèõ ãðóï ïàö³ºíò³â.
Äëÿ ðîçâèòêó â³äïîâ³äíî¿ ÿêîñò³ îòðèìàíèõ äà-
íèõ äîñë³äæåíü íåîáõ³äíî òàêîæ çàáåçïå÷èòè
á³ëüøå ôîðìàëüíî¿ ï³äãîòîâêè äèñåðòàíò³â ç ìå-
òîäîëî㳿 äîñë³äæåíü. Òàêå íàâ÷àííÿ çàçâè÷àé º
äîñòóïíèì íà ìåäè÷íèõ ôàêóëüòåòàõ, îð³ºíòîâà-
íèõ íà äîñë³äæåííÿ, â ôîðì³ êóðñ³â ç³ ñòàòèñòèêè,
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
åòèêè, äèçàéíó äîñë³äæåíü, êîðèñòóâàíí³ á³áë³îòå-
êîþ ³ íàïèñàíí³ íàóêîâèõ ïðàöü.
Òàêîæ áóëè îðãàí³çîâàí³ êóðñè ç ðåàá³ë³òàö³éíèõ
äîñë³äæåíü, ñïåö³àëüíî íàö³ëåí³ íà ºâðîïåéñüêèõ
äèñåðòàíò³â, çàçâè÷àé ó ñï³âïðàö³ ì³æ äâîìà ºâðî-
ïåéñüêèìè óí³âåðñèòåòàìè. Òàê³ òèæíåâ³ êóðñè íå
ò³ëüêè ñïðèÿþòü çóñòð³÷àì òà âçàºìî䳿 äèñåð-
òàíò³â ç ðåàá³ë³òàö³¿ ç ð³çíèõ ºâðîïåéñüêèõ óí³âåð-
ñèòåò³â, àëå òàêîæ äàþòü îñíîâó äëÿ ñòâîðåííÿ
ìåðåæåâî¿ âçàºìî䳿 äëÿ ìàéáóòí³õ äîñë³äæåíü.
Ñòðóêòóðà öèõ êóðñ³â äîòðèìóºòüñÿ ̳æíàðîäíî¿
êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ, îáìåæåíü æèòòºä³-
ÿëüíîñò³ òà çäîðîâ’ÿ109 ÂÎÎÇ, ç ðîçä³ëàìè ç ìå-
òîäîëî㳿 îö³íêè óðàæåíü110, äëÿ îö³íþâàííÿ àêòèâ-
íîñò³ òà äëÿ îö³íþâàííÿ ó÷àñò³. Àêöåíò áóëî
çðîáëåíî íà äèçàéí³ êîíòðîëüîâàíèõ äîñë³äæåíü,
ï³äêðåñëþþ÷è íåîáõ³äí³ñòü îá÷èñëåííÿ ïðîäóê-
òèâíîñò³ òà íåîáõ³äíîñò³ íåçàëåæíèõ ñïîñòåð³ãà÷³â.
Îñê³ëüêè áàãàòî âàæëèâèõ ³íñòðóìåíò³â, ùî âèêî-
ðèñòîâóþòüñÿ â ðåàá³ë³òàö³éíèõ äîñë³äæåííÿõ, ïðî-
äóêóþòü îðäèíàðí³ äàí³, àêöåíò â ñòàòèñòè÷í³é ÷à-
ñòèí³ êóðñó áóâ çðîáëåíèé íà àíàë³ç³ Rasch òà
³íñòðóìåíòàõ, ÿê³ ïðîéøëè òàêèé àíàë³ç111. Âñ³ì äè-
ñåðòàíòàì, ùî áåðóòü ó÷àñòü â êóðñàõ, áóëî çàï-
ðîïîíîâàíî çðîáèòè ³ ïðèíåñòè ïîñòåð ç äåÿêèìè
ç³ ñâî¿õ âëàñíèõ äàíèõ, ³ ö³ ïîñòåðè îáãîâîðþâàëè-
ñÿ ñåðåä ó÷àñíèê³â ³ âèêëàäà÷³â ïðîòÿãîì
ïîñòåðíèõ ñåñ³é, ÿê³ äóæå äîáðå ñïðèéìàëèñü. Ñïî-
ä³âàºìîñü, ùî ö³ êóðñè áóäóòü íàäàë³ âäîñêîíàëþ-
âàòèñÿ ³ âêëþ÷àòèìóòü ñïåöèô³÷í³ ï³äãàëóç³, òàê³
ÿê äîñë³äæåííÿ ç ðåàá³ë³òàö³¿ ïàö³ºíò³â ç ñïèííî-
ìîçêîâèìè òðàâìàìè, äîñë³äæåííÿ, ïîâ’ÿçàí³ ç
÷åðåïíî-ìîçêîâîþ òðàâìîþ, ³íñóëüòîì òà ì’ÿçî-
âî-ñêåëåòíèìè ñòàíàìè.
Íàâ÷àííÿ äëÿ äîñë³äæåííÿ
ª äîáðå â³äîìèì, ùî ë³êàð³, ÿê³ òàêîæ ïðàöþ-
þòü, ÿê àêàäåì³÷í³ ôàõ³âö³, ìàþòü òðè îñíîâí³ ðîë³.
Ïåðø çà âñå, âîíè ïîâèíí³ çàáåçïå÷èòè íàéêðàùó
äîïîìîãó â îõîðîí³ çäîðîâ’ÿ ñâî¿ì ïàö³ºíòàì. Ïî-
äðóãå, âîíè ïîâèíí³ íàâ÷àòè ðåçèäåíò³â/ñòóäåíò³â,
³, íàïðèê³íö³, àëå íå â îñòàííþ ÷åðãó, âîíè ïîâèíí³
ïðîâîäèòè äîñë³äæåííÿ. Ç îäíîãî áîêó, ö³ òðè êðî-
êè, çäàºòüñÿ, øèêóþòüñÿ â ïîðÿäêó çìåíøåííÿ
âàæëèâîñò³. Ïðè öüîìó, â åðó äîêàçîâî¿ ìåäèöè-
íè112 æîäåí ë³êàð íå ìຠïðàâà ââàæàòèñÿ «åêñïåð-
òîì» ³ îáõîäèòè íåîáõ³äí³ñòü çàéìàòèñÿ äîñë³ä-
æåííÿìè. Êð³ì òîãî, ÿêùî õòîñü ââàæàº, ùî â³í/
âîíà ë³êóº éîãî/¿¿ ïàö³ºíò³â íàëåæíèì ÷èíîì, ¿ì
ïîòð³áíî ñïî÷àòêó äîâåñòè öå (äîñë³äæåííÿ), ïå-
ðåêîíàòè ³íøèõ (åêñïåðòíà îö³íêà), à ïîò³ì ïîÿñ-
íèòè/ïîä³ëèòèñÿ «ìåòîäîì» (íàóêîâà ïóáë³êàö³ÿ).
Òàêèì ÷èíîì, ³íø³ êîëåãè áóäóòü êîðèñòóâàòèñÿ
«ìåòîäîì» ³, éìîâ³ðíî, ï³äâèùàòü åôåêòèâí³ñòü
187
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ñâî¿õ âòðó÷àíü, îñê³ëüêè ìè º ë³êàðÿìè, ÿê³ ìàþòü
ñïðàâó ç ëþäüìè.
³äïîâ³äíî, ï³äãîòîâêà ë³êàð³â ô³çè÷íî¿ òà ðåà-
á³ë³òàö³éíî¿ ìåäèöèíè îáîâ’ÿçêîâî ïîâèííà áóòè
äîñë³äíèöüêîþ. Òàêèé ï³äõ³ä òàêîæ ìຠâèð³øàëü-
íå çíà÷åííÿ äëÿ çì³öíåííÿ “îñíîâ” ô³çè÷íî¿ òà ðåà-
á³ë³òàö³éíî¿ ìåäèöèíè. Ñòîñîâíî äî ïîòåíö³éíèõ çàã-
ðîç äëÿ ñïåö³àëüíîñò³ ÔÐÌ, ÿê (íàïð. â³äñóòí³ñòü
÷³òêèõ äîêàç³â ùîäî åôåêòèâíîñò³ äåÿêèõ ðåàá³ë³-
òàö³éíèõ ïðîöåäóð àáî äåÿêèõ ïåðåòèí³â ç ³íøèìè
ì’ÿçîâî-ñêåëåòíèìè ñôåðàìè), ìè ïîâèíí³ ñïðèÿòè
äîñë³äæåííÿì. Öüîãî ìîæíà äîñÿãòè çàâäÿêè áåç-
ë³÷÷þ ³íñòðóìåíò³â îö³íþâàííÿ, ùî âèêîðèñòîâó-
þòüñÿ ë³êàðÿìè ÔÐÌ. Âîíè âêëþ÷àþòü óëüòðàçâó-
êîâó â³çóàë³çàö³þ, ³çîê³íåòè÷í³ ñèñòåìè,
åëåêòðîì³îãðàô³þ, ðåºñòðàö³þ ìîòîðíèõ âèêëèêàíèõ
ïîòåíö³àë³â, àíàë³ç õîäüáè àáî ³íø³ òåõíîëî㳿, ÿê³
äåòàëüíî îö³íþþòü ð³çí³ ïàðàìåòðè ñòðóêòóðè ³ ñèëè/
ôóíêö³¿ ì’ÿçîâî-ñêåëåòíî¿ ñèñòåìè113. Ñë³ä ìàòè íà
óâàç³, ùî ê³ëüê³ñíå âèçíà÷åííÿ îçíà÷ຠíîâ³ äàí³, ÿê³
ìîæóòü ïðîÿñíèòè ïèòàííÿ, íåçðîçóì³ë³ ðàí³øå.
Çá³ëüøåííÿ ê³ëüêîñò³ äîñë³äæåíü/ïóáë³êàö³é ó
ãàëóç³ ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè â îñ-
òàíí³ ðîêè, çäàºòüñÿ ïåðñïåêòèâíèì114,115. Ïðè öüî-
ìó ñë³ä çàçíà÷èòè, ùî íàÿâí³ñòü øèðîêîãî ñïåêò-
ðó äîñë³äíèöüêèõ îáëàñòåé, ïî÷èíàþ÷è ç âàë³äàö³¿
³íñòðóìåíò³â îö³íþâàííÿ, äî âèçíà÷åííÿ ïðîãíîñ-
òè÷íèõ ôàêòîð³â òà äî ñòâîðåííÿ íîâ³òí³õ ðåàá³ë³-
òàö³éíèõ òåõíîëîã³é, çîêðåìà ïðè ö³ëîìó ðÿä³ íå-
ðâîâèõ òà ì’ÿçîâî-ñêåëåòíèõ çàõâîðþâàíü (íàïð.
³íñóëüò, ñïèííîìîçêîâà òðàâìà, îñòåîïîðîç, ðåâ-
ìàòè÷í³ çàõâîðþâàííÿ òîùî) – º äóæå êîðèñíîþ75.
Àíàëîã³÷íî, â çàëåæíîñò³ â³ä ³íäèâ³äóàëüíèõ ïðî-
ôåñ³éíèõ êóëüò³â àáî ³íòåðåñ³â òà ì³ñöåâèõ óìîâ
(êë³í³÷íèé çàêëàä, ïîïóëÿö³ÿ ïàö³ºíò³â òîùî), ë³êàð³
ÔÐÌ ïðîâîäÿòü ð³çíîìàí³òí³ äîñë³äæåííÿ, ÿê³ òà-
êîæ â³ääçåðêàëþþòüñÿ íà íàóêîâîìó ðåçóëüòàò³.
Âàæëèâî â³äçíà÷èòè, ùî, ïðè âèêîíàíí³ â³äïîâ³ä-
íîãî ïîøóêó â Web of Science, ïóáë³êàö³¿ ç ÔÐÌ
ìîæóòü áóòè çíàéäåí³ â ð³çíèõ êàòåãîð³ÿõ æóðíàë³â,
³íøèõ, í³æ ðåàá³ë³òàö³ÿ (íàïð. êë³í³÷íà íåâðîëîã³ÿ,
ðåâìàòîëîã³ÿ, ñïîðòèâí³ íàóêè, îðòîïåä³ÿ) (Òàáëèöÿ
²À). Àíàëîã³÷íèé ïîøóê òàêîæ ìîæå äàòè óÿâëåííÿ
ùîäî êðà¿í (Òàáëèöÿ ²Á) òà æóðíàë³â ç âèñîêèì
ðåéòèíãîì ó êàòåãî𳿠ðåàá³ë³òàö³¿ (Òàáëèöÿ ²Â).
Çàóâàæóºìî, ùî ï³ä ÷àñ öüîãî ïîøóêó â ÿêîñò³
êëþ÷îâèõ ñë³â â àäðåñíîìó ðîçä³ë³ Web of Science
âèêîðèñòîâóâàëèñÿ «rehabil* òà med*» çàäëÿ óíèê-
íåííÿ âèêëþ÷åííÿ àâòîð³â, ÿê³ âêàçàëè ñâîþ àä-
ðåñíó ïðèíàëåæí³ñòü, íå âèêîðèñòîâóþ÷è ñëîâî
«ô³çè÷íà ìåäèöèíà», à òàêîæ ùîá óíèêíóòè ïåð-
âèííîãî âêëþ÷åííÿ íåìåäè÷íèõ ôàõ³âö³â îõîðîíè
çäîðîâ’ÿ, ÿê³ ïðàöþþòü â ðåàá³ë³òàö³éíèõ íàóêàõ.
Áåççàïåðå÷íî, öåé òèï ïîøóêó ìîæå áóòè âèêîðè-
ñòàíèé ëèøå äëÿ òîãî, ùîá ìàòè çàãàëüíó ³äåþ –
íå äëÿ òî÷íîãî ãëèáèííîãî àíàë³çó.
188 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Íà çàê³í÷åííÿ, îáñÿã äîñë³äæåíü â íàø³é îá-
ëàñò³ çðîñòàº, ³ öå, çäàºòüñÿ, â³äáóâàºòüñÿ øâèä-
øå, í³æ çðîñòàííÿ ê³ëüêîñò³ ñòîð³íîê, äîñòóïíèõ â
æóðíàëàõ ç ðåàá³ë³òàö³¿.
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107. Horizon 2020. Horizon 2020 projects – European
Commission [Internet]. Available from: https://ec.europa.eu/
programmes/horizon2020/en/h2020-sections-projects.
108. Kjaersgaard A., Nielsen L.H., Sj lund B.H. Randomized trial
of two swallowing assessment approaches in patients with
acquired brain injury: Facial-Oral Tract Therapy versus
Fibreoptic Endoscopic Evaluation of Swallowing. Clin
Rehabil. 2014 Mar; 28(3):243–53.
109. WHO. International Classification of Functioning, Disability
and Health WHO Geneva 2001. 2001.
110. Barat M., Franchignoni F. Assessment in physical medicine
and rehabilitation views and perspectives. Maugeri Founda-
tion Books. 2004.
111. Arsalis. Outcome application [Internet]. Available from:
http://www.arsalis.com/outcome.html#outcome-overview-en.
112. Franchignoni F., Oz akar L., Michail X., Vanderstraeten G.,
Christodoulou N., Frischknecht R. Publishing in Physical and
rehabilitation medicine. An update on the European point
of view. Eur J Phys Rehabil Med. 2013 Oct;49(5):711–4.
113. Ulaºli A.M., Kara M., z akar L. Publications of physical
and rehabilitation medicine physicians concerning
musculoskeletal ultrasonography: an overview. J Rehabil
Med. 2011 Jul;43(8):681–3.
114. Franchignoni F., Mu oz Lasa S., Ozçakar L., Ottonello M.
Bibliometric indicators: a snapshot of the scientific produc-
tivity of leading European PRM researchers. Eur J Phys
Rehabil Med. 2011 Sep;47(3):455–62.
115. Kara M., Ozçakar L., Kaymak B., Ozel S., Aknc A. Scientific
publications in physical and rehabilitation medicine: a glance
from Turkey. Am J Phys Med Rehabil. 2011 Jul;90(7):
612–4.

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Alain Delarque,
Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Christoph Gutenbrunner, Carlotte Kiekens,
Sasa Moslavac, Enrique Varela-Donoso, Anthony B Ward, Mauro Zampolini, Stefano Negrini.
• Ó÷àñíèêè: Alain Delarque, Franco Franchignoni, Levent Oscakar, Michael Quittan, Bengt H. Sjolund, Henk
J. Stam, Gerold Stucki, Catarina Aguiar Branco, Pedro Cantista, Maria Gabriella Ceravolo, Gunnar Grimby,
Christoph Gutenbrunner, Stefano Negrini, Joao Pascoa Pinheiro, Katharina Stibrant Sunnerhagen, Luigi
Tesio, Frederic Brocard, Kristian Borg, Alain Delarque, Walter Frontera, Francesca Gimigliano, Thierry
Lejeune, Diane Playford, Alan Tennant, Andre Thevenon, Stuart M.Weinstein.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ.

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 191
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Äîäàòîê 1. – Îíîâëåíèé ïåðåë³ê íàóêîâèõ òåì ISPRM

Íà îñíîâ³ âèùåîïèñàíèõ îñíîâíèõ ì³ðêóâàíü A.3.2. ×åðåïíî-ìîçêîâà òðàâìà

³ îö³íêè âèêîðèñòàííÿ ïåðøîãî çàïðîïîíîâàíîãî A.3.3. Ñïèííîìîçêîâ³ òðàâìè òà ³íø³ õâîðîáè ñïèí-
ñïèñêó òåì ISPRM áóâ âèâåäåíèé íàñòóïíèé îíîâ- íîãî ìîçêó
ëåíèé ñïèñîê (îñíîâí³ çì³íè º ï³äêðåñëåíèìè): A.3.4. Àâòî³ìóíí³ òà çàïàëüí³ íåâðîëîã³÷í³ ñòàíè
Öÿ ïðîïîçèö³ÿ âêëþ÷ຠòåìè, ÿê³ íå çãàäóþòü- (íàïð. ìíîæèííèé ñêëåðîç)
ñÿ â ïåðø³é ïðîïîçèö³¿ òà âäîñêîíàëåíèé ñèñòåìà- A.3.5. Íåéðîäåãåíåðàòèâí³ çàõâîðþâàííÿ (íàïð.
òè÷íèé ïîðÿäîê òåì. äåìåíö³ÿ)
A.3.6. Òðàâìà ïåðèôåðè÷íèõ íåðâ³â
A. Êë³í³÷í³ íàóêè ç ô³çè÷íî¿ A.3.7. Âåãåòàòèâí³ ñòàíè, ñòàíè ç ì³í³ìàëüíîþ àáî
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè çíèæåíîþ ñâ³äîì³ñòþ
A.3.8. гçíå
Îïèñ: êë³í³÷í³ ðåàá³ë³òàö³éí³ íàóêè âèâ÷àþòü, ÿê A.4. Ñòàíè ïñèõ³÷íîãî çäîðîâ’ÿ
çàáåçïå÷èòè íàéêðàùó äîïîìîãó ç ìåòîþ óìîæ- A.4.1. Òðèâîãà, äåïðåñ³ÿ, á³ïîëÿðí³ ðîçëàäè
ëèâëåííÿ ëþäÿì, ÿê³ çàçíàþòü, àáî ìîæóòü çàçíà- A.4.2. Ïîðóøåííÿ çäàòíîñò³ äî íàâ÷àííÿ
òè îáìåæåíü æèòòºä³ÿëüíîñò³, äîñÿãòè òà ï³äòðè- A.4.3. Çàëåæíîñò³
ìóâàòè îïòèìàëüíå ôóíêö³îíóâàííÿ ïðè âçàºìî䳿 A.4.4. ²íø³ ñòàíè ïñèõ³÷íîãî çäîðîâ’ÿ
ç³ ñâî¿ì íàéáëèæ÷èì ñåðåäîâèùåì. Öå ì³ñòèòü A.5. Âíóòð³øíÿ ìåäèöèíà òà ïîâ’ÿçàí³ ñòàíè
êë³í³÷í³ äîñë³äæåííÿ ùîäî íàéêðàùî¿ äîïîìîãè, A.5.1. Ñåðöå òà ñåðöåâî-ñóäèííà ñèñòåìà
âêëþ÷àþ÷è íàñòàíîâè òà ñòàíäàðòè, îðãàí³çàö³þ A.5.2. Çàõâîðþâàííÿ ë³ìôàòè÷íî¿ ñèñòåìè
òà óïðàâë³ííÿ ÿê³ñòþ. ¹ À.1.-À.5. ïîâ’ÿçàí³ ç ñïå- A.5.3. Ëåãåíåâ³ çàõâîðþâàííÿ
öèô³÷íèìè ñòàíàìè çäîðîâ’ÿ; A.6. – A.11. ç ïèòàí- A.5.4. Õâîðîáè ðîòà-ãîðòàí³-ãëîòêè
íÿìè ôóíêö³îíóâàííÿ òà â³äïîâ³äíèìè ö³ëÿìè A.5.5. Ìåòàáîë³÷í³ ðîçëàäè (íàïð. îæèð³ííÿ,
ðåàá³ë³òàö³¿. öóêðîâèé ä³àáåò)
A.5.6. Ðàê
A.1. Á³ëü1 A.5.7. ²íôåêö³éí³ çàõâîðþâàííÿ
A.1.1. Ãîñòðèé á³ëü A.5.8. Ðîçëàä øê³ðè òà àëåð㳿
A.1.2. Õðîí³÷í³ ãåíåðàë³çîâàí³ áîëüîâ³ ñèíäðîìè A.5.9. Ðîçëàäè ñå÷îâîãî ì³õóðà òà êèøê³âíèêà
(âêëþ÷àþ÷è ô³áðîì³àëãèþ) A.5.10. Óðî-ã³íåêîëîã³÷í³ ðîçëàäè (â ò.÷. àêó-
A.1.3. Êîìïëåêñí³ ðåã³îíàëüí³ áîëüîâ³ ñèíäðîìè øåðñüê³ ïðîöåäóðè)
A.1.4. гçíå A.5.11. гçíå
À.2. Ì’ÿçîâî-ñêåëåòí³ ñòàíè À.6. ϳñëÿõ³ðóðã³÷íà ³ ï³ñëÿòðàâìàòè÷íà ðåàá³ë³-
A.2.1. Çàïàëüí³ çàõâîðþâàííÿ ñóãëîá³â (íàïð. ðåâ- òàö³ÿ3
ìàòî¿äíèé àðòðèò, àíê³ëîçóþ÷èé ñïîíäèë³ò) A.6.1. Ì’ÿçîâîñêåëåòí³ óðàæåííÿ, ïåðåëîìè ê³ñòîê
A.2.2. Äåãåíåðàòèâí³ çàõâîðþâàííÿ ñóãëîá³â A.6.2. Ìíîæèííà òðàâìà
(íàïð. îñòåîàðòðèò) 2 A.6.3. Îï³êîâå óðàæåííÿ.
A.2.3. Õâîðîáè ê³ñòîê (íàïð. îñòåîïîðîç) A.6.4. Òðàíñïëàíòàö³ÿ îðãàí³â
A.2.4. Ëîêàëüí³ òà ðå´³îíàðí³ áîëüîâ³ ñèíäðîìè øè¿ À.6.5. Àðòðîïëàñòèêà ñóãëîáó / çàì³íà ñóãëîáó
òà âåðõí³õ ê³íö³âîê (âêëþ÷àþ÷è åíòåçîïàò³þ, À.6.6. Àìïóòàö³ÿ ê³íö³âêè
òåíäèí³ò òà ³íø³) A.6.7. гçíå
A.2.5. Ðå´³îíàðí³ áîëüîâ³ ñèíäðîìè òàçó òà íèæíüî¿ À.7. Ðåàá³ë³òàö³ÿ äëÿ ä³òåé òà ìîëîä³
ê³íö³âêè (âêëþ÷àþ÷è åíòåçîïàò³þ, òåíäèí³ò òà A.7.1. Ðîçëàäè ðîçâèòêó
³íø³) A.7.2. Öåðåáðàëüíèé ïàðàë³÷
A.2.6. Á³ëü â ñïèí³ òà ðîçëàäè õðåáòà A.7.3. Spina bifida
A.2.7. Ì’ÿçîâî-ñêåëåòíà òðàâìà (íàïð. ïåðåëîìè) À.7.4. ×åðåïíî-ìîçêîâà òðàâìà ó ä³òåé
A.2.8. Ñïîðòèâíà òðàâìà A.7.5. Þâåí³ëüíèé ðåâìàòî¿äíèé àðòðèò
A.2.9. гçíå A.7.6. ²íôåêö³éí³ õâîðîáè ó ä³òåé òà ìîëîä³
A.3. Ñòàíè çäîðîâ’ÿ íåðâîâî¿ ñèñòåìè A.7.7. Àóòèçì òà ³íø³ ïñèõ³÷í³ ðîçëàäè ó ä³òåé
A.3.1. ²íñóëüò (âêëþ÷àþ÷è ñèíäðîì äåô³öèòó óâàãè)
A.7.8. гçíå
1
Á³ëü ìîæå áóòè êëàñèô³êîâàíèé, ÿê ñòàí çäîðîâ’ÿ òà ôóíêö³ÿ
îðãàí³çìó
2
Àðòðîïëàñòèêà / çàì³íà ñóãëîá³â êëàñèô³êóþòüñÿ â ï³ñëÿ 3
×åðåïíî-ìîçêîâà òà ñïèííîìîçêîâà òðàâìè – â ñòàíàõ íåðâîâî¿
õ³ðóðã³÷í³é ðåàá³ë³òàö³¿ ñèñòåìè

192 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018
 ÐÎÇÄ²Ë 10 – ÍÀÓÊÀ ÒÀ ÄÎÑ˲ÄÆÅÍÍß Ó ÔÐÌ: ÎÑÎÁËÈÂÎÑÒ² ÒÀ ÏÐÎÁËÅÌÈ
A.8. Ðåàá³ë³òàö³ÿ ëþäåé ë³òíüîãî â³êó4
A.8.1. Äåìåíö³ÿ
A.8.2. Êâîë³ñòü
A.8.3. Ñàðêîïåí³ÿ
A.8.4. Äåïðåñèâíèé ðîçëàä ó ëþäåé ë³òíüîãî â³êó
A.8.5. Ðèçèê ïàä³ííÿ ó ëþäåé ë³òíüîãî â³êó
A.8.6. ²íø³ ãåð³àòðè÷í³ ñòàíè
A.9. Ðåàá³ë³òàö³ÿ äëÿ ëþäåé ç ð³äê³ñíèìè (îðôàí-
íèìè) õâîðîáàìè5
À.10. Ðåàá³ë³òàö³ÿ, ùî ñïðÿìîâàíà íà âèð³øåííÿ
êîíêðåòíèõ ïèòàíü ôóíêö³îíóâàííÿ
À.10.1. Ïîðóøåííÿ çîðó ³ ñë³ïîòà
À.10.2. Ñëóõîâ³ ïîðóøåííÿ ³ ãëóõîòà
A.10.3. Äèñôóíêö³ÿ ìîâè òà ìîâëåííÿ (âêëþ÷àþ-
÷è í³ìîòó)
A.10.4. Ñåíñîðíèé ³ ìîòîðíèé êîíòðîëü (âêëþ÷à-
þ÷è ïîñòóðàëüíèé êîíòðîëü)
A.10.5. Ìåíåäæìåíò ñïàñòè÷íîñò³
A.10.6. Ìåíåäæìåíò ãåìèïëå㳿 òà ïàðàïëå㳿
A.10.7. Ìåíåäæìåíò äèñôà㳿
A.10.8. Ðåñï³ðàòîðí³ ðîçëàäè (âêëþ÷àþ÷è ìåíåä-
æìåíò ïàö³ºíò³â ç³ øòó÷íîþ âåíòèëÿö³ºþ
³ â³äëó÷åííÿ â³ä íå¿)
A.10.9. Íåäîñòàòíº õàð÷óâàííÿ â ðåàá³ë³òàö³¿
A.10.10. Ñô³íêòåðíà äèñôóíêö³ÿ (âêëþ÷àþ÷è íå-
òðèìàííÿ)
A.10.11. Ìåíåäæìåíò ðàí ³ ïðîëåæí³â
A.10.12. Ìåíåäæìåíò âòîìè ³ ïîðóøåíü ñíó
A.10.13. Ðåàá³ë³òàö³ÿ ïñèõ³÷íî¿ äèñôóíêö³¿, ïîâ’ÿ-
çàíî¿ ç îáìåæåííÿì æèòòºä³ÿëüíîñò³ (íàïð. äåï-
ðåñ³ÿ, òðèâîãà)
A.10.14. Ñåêñóàëüíå ôóíêö³îíóâàííÿ ó ëþäåé ç
îáìåæåííÿìè æèòòºä³ÿëüíîñò³ òà õðîí³÷íèìè ñòà-
íàìè çäîðîâ’ÿ
A.10.15. ²íø³ ñïåö³àëüí³ ôóíêö³¿
A.11. Ñïîðòèâíà ðåàá³ë³òàö³ÿ
A.12. гçíå
B. Á³îëîã³÷í³ íàóêè â ðåàá³ë³òàö³¿
Îïèñ: á³îëîã³÷í³ íàóêè â îáëàñò³ ðåàá³ë³òàö³¿ º ôóí-
äàìåíòàëüíèìè íàóêàìè, ìåòîþ ÿêèõ º ïîÿñíèòè
ïîøêîäæåííÿ îðãàí³çìó, àäàïòàö³þ òà ðåïàðàö³þ
â³ä ìîëåêóëÿðíîãî äî êë³òèííîãî ð³âí³â, ð³âí³â ñè-
ñòåì îðãàí³â òà îðãàí³çìó; ³ âèçíà÷èòè ö³ë³ äëÿ á³î-
ìåäè÷íèõ âòðó÷àíü äëÿ ïîë³ïøåííÿ ôóíêö³é
ñòðóêòóð îðãàí³çìó.
B.1. Ìåõàí³çìè ïîøêîäæåííÿ òêàíèí (íàïð. çàïà-
ëåííÿ, ïîâòîðþâàíå ðîçòÿãíåííÿ) ³ ðîçâèòîê
äèñôóíêö³¿ îðãàíó (íàïð. àòðîô³ÿ, ñïàñòè÷í³ñòü,
õðîí³÷íèé á³ëü)
4
Öåé ðîçä³ë òàêîæ âêëþ÷ຠïèòàííÿ ôóíêö³îíóâàííÿ
5
Âêëþ÷íî ³ç êë³í³÷íèìè âèïàäêàìè ñïåöèô³÷íèõ ðåàá³ë³òàö³éíèõ
ïèòàíü
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
B.2. Àäàïòàö³ÿ ³ ìàëàäàïòàö³ÿ êë³òèí ³ òêàíèí
(íàïð. ïëàñòè÷í³ñòü, ìîëåêóëÿðí³ ìåõàí³çìè òà
ìåä³àòîðè)
B.3. Âåãåòàòèâíå ðåãóëþâàííÿ (ó òîìó ÷èñë³ HPA-
â³ñü, ñèñòåìè ãîðìîíàëüíîãî ðåãóëþâàííÿ)
B.4. Á³îëîã³÷íèé ìåõàí³çì âòðó÷àíü (íàïð. ïîëåã-
øåííÿ áîëþ, ìîòîðíå íàâ÷àííÿ)
B.5. гçíå
C. Á³îìåäè÷í³ ðåàá³ë³òàö³éí³ íàóêè
òà ³íæåíåð³ÿ
Îïèñ: á³îìåäè÷í³ ðåàá³ë³òàö³éí³ íàóêè òà ³íæåíå-
ð³ÿ – öå ïðèêëàäí³ íàóêè, ùî âèâ÷àþòü ä³àãíîñòè÷í³
çàõîäè òà âòðó÷àííÿ, âêëþ÷àþ÷è ô³çè÷í³ ìîäàëü-
íîñò³, ùî äîçâîëÿþòü ì³í³ì³çóâàòè ïîðóøåííÿ,
êîíòðîëþâàòè ñèìïòîìè òà îïòèì³çóâàòè
çäàòí³ñòü îñîáè.
C.1. ijàãíîñòèêà ó Ô³çè÷í³é òà Ðåàá³ë³òàö³éí³é
Ìåäèöèí³ (ÔÐÌ) (íàïð. ñåðöåâî-ñóäèíí³ ôóíêö³¿
³ ô³çè÷íà âèòðèâàë³ñòü, òåñòóâàííÿ ôóíêö³¿
ëåãåí³â àáî ìåòîäè â³çóàë³çàö³¿) â³äïîâ³äíî äî
ñèñòåì îðãàí³â ³ ôóíêö³é îðãàí³çìó (íà îñíîâ³ ïåð-
øîãî ð³âíÿ êîìïîíåíòó «ôóíêö³¿ îðãàí³çìó» ̳æíà-
ðîäíî¿ êëàñèô³êàö³¿ ôóíêö³îíóâàííÿ, îáìåæåíü
æèòòºä³ÿëüíîñò³ òà çäîðîâ’ÿ (ÌÊÔ))
C.1.1. ijàãíîñòèêà òà îö³íþâàííÿ ïñèõ³÷íèõ
ôóíêö³é (âêëþ÷àþ÷è íåéðîïñèõîëîã³÷íå îö³íþ-
âàííÿ)
C.1.2. ijàãíîñòèêà òà îö³íþâàííÿ ñåíñîðíèõ
ôóíêö³é ³ áîëþ
Ñ.1.3. ijàãíîñòèêà òà îö³íþâàííÿ ôóíêö³é ãîëîñó
òà ìîâëåííÿ
Ñ.1.4. ijàãíîñòèêà òà îö³íþâàííÿ ôóíêö³é ñåðöå-
âî-ñóäèííî¿, ãåìàòîëîã³÷íî¿, ³ìóíîëîã³÷íî¿ òà ðåñ-
ï³ðàòîðíî¿ ñèñòåì
Ñ.1.5. ijàãíîñòèêà òà îö³íþâàííÿ ôóíêö³é òðàâíî¿,
ìåòàáîë³÷íî¿ òà åíäîêðèííî¿ ñèñòåì
C.1.6. ijàãíîñòèêà òà îö³íþâàííÿ ñå÷îñòàòåâî¿ òà
ðåïðîäóêòèâíî¿ ôóíêö³é
C.1.7. ijàãíîñòèêà òà îö³íþâàííÿ íåâðîëîã³÷íèõ,
ì’ÿçîâî-ñêåëåòíèõ ôóíêö³é òà ôóíêö³é, ïîâ’ÿçàíèõ
ç ðóõîì (âêëþ÷àþ÷è àíàë³ç õîäè, ïîñòóðîãðà-
ô³þ)
C.1.8. ijàãíîñòèêà òà îö³íþâàííÿ ôóíêö³é øê³ðè ³
ïîâ’ÿçàíèõ ç íåþ ñòðóêòóð
C.1.9. Îö³íþâàííÿ ñïðèéíÿòòÿ çäîðîâ’ÿ òà ÿêîñò³
æèòòÿ
C.1.10. гçíå
Ñ.2. Äîñë³äæåííÿ âòðó÷àíü ÔÐÌ
Ñ.2.1. Âïðàâà
Ñ.2.2. Òðåíóâàííÿ ì’ÿç³â
Ñ.2.3. Åðãîíîì³êà
193
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
Ñ.2.4. Ìåòîäè ìîá³ë³çàö³¿ òà ìàí³ïóëÿö³¿ ñóãëîá³â
Ñ.2.5. Ïðîòåçóâàííÿ òà îðòåçóâàííÿ
Ñ.2.6. Ìàñàæ ³ ì³îôàñö³àëüí³ òåõí³êè
Ñ.2.7. ³áðàö³ÿ ³ ³íøà ìåõàí³÷íà ñòèìóëÿö³ÿ
Ñ.2.8. Òðàíñêðàí³àëüíà ìàãí³òíà ñòèìóëÿö³ÿ
C.2.9. ˳ìôîòåðàï³ÿ (ìàíóàëüíèé ë³ìôàòè÷íèé
äðåíàæ)
C.2.10. Òåïëî ³ õîëîä
C.2.11. óäðîòåðàï³ÿ òà áàëüíåîòåðàï³ÿ
C.2.12. Ñâ³òëî (âêëþ÷àþ÷è ÓÔ)
C.2.13. Êë³ìàòîòåðàï³ÿ
C.2.14. Åëåêòðîòåðàï³ÿ (âêëþ÷àþ÷è ôóíêö³î-
íàëüíó åëåêòðîô³ç³îëîã³÷íó ñòèìóëÿö³þ)
C.2.15. Ôàðìàêîëîã³÷í³ âòðó÷àííÿ (íàïð. ïðè
áîëþ, ñïàñòè÷íîñò³, ïðîòèçàïàëüí³ ïðåïàðàòè)
C.2.16. Áëîêàäà íåðâîâèõ êîð³íö³â òà ëîêàëüí³
³íô³ëüòðàö³¿
C.2.17. Àêóïóíêòóðà òà äîäàòêîâ³ ³ àëüòåðíàòèâí³
òåðàﳿ
C.2.18. Õàð÷óâàííÿ òà 䳺òà
C.2.19. ³ðòóàëüíà ðåàëüí³ñòü, êîìï’þòåðí³ ³ãðè,
ÿê³ ïåðåäáà÷àþòü ô³çè÷í³ íàâàíòàæåííÿ
C.2.20. Òåõíîëî㳿 ðåàá³ë³òàö³¿, âêëþ÷àþ÷è ³ìïëàí-
òè, ïðîòåçè, îðòåçè
C.2.21. Ðîáîòè, çàñîáè òà ïðèñòðî¿
C.2.22. Ñïîðò ó ðåàá³ë³òàö³¿
C.2.23. Òåõí³ê³ ³í’ºêö³¿ òà ³íô³ëüòðàö³¿
C.2.24. Õ³ðóðã³÷í³ âòðó÷àííÿ â ðåàá³ë³òàö³¿
C.2.25. гçíå
Ñ.3. Êîìïëåêñíà ïðîãðàìà ðåàá³ë³òàö³¿ (äîñë³äæåí-
íÿ áåçïåðåðâíî¿ äîïîìîãè)
Ñ.3.1. Ãîñòð³ ³ ðàíí³ ï³äãîñòð³ ðåàá³ë³òàö³éí³ ïðî-
ãðàìè
Ñ.3.2. ϳäãîñòð³ ðåàá³ë³òàö³éí³ ïðîãðàìè
Ñ.3.3. Äîâãîòðèâàë³ ðåàá³ë³òàö³éí³ ïðîãðàìè
Ñ.3.4. Ïåð³îäè÷í³ (ñòèìóëþþ÷³) ðåàá³ë³òàö³éí³ ïðî-
ãðàìè äëÿ õðîí³÷íèõ ñòàí³â
Ñ.3.5. Ïðîãðàìè ïðîô³ëàêòèêè îáìåæåíü æèòòº-
ä³ÿëüíîñò³
Ñ.3.6. гçíå
Ñ.4. гçíå
D. ²íòåãðàòèâí³ ðåàá³ë³òàö³éí³ íàóêè
Îïèñ: ³íòåãðàòèâí³ ðåàá³ë³òàö³éí³ íàóêè ðîçðîáëÿ-
þòü ³ âèâ÷àþòü ñèñòåìè ³ ïîñëóãè ðåàá³ë³òàö³¿,
êîìïëåêñí³ ïðîãðàìè îö³íþâàííÿ òà âòðó÷àíü, ÿê³
îá’ºäíóþòü á³îìåäè÷í³, ïåðñîíàëüí³ ôàêòîðè ³ ñå-
ðåäîâèùí³ ï³äõîäè, ÿê³ ï³äõîäÿòü äëÿ îïòèì³çàö³¿
âèêîíàííÿ ëþäåé. Öåé ðîçä³ë âêëþ÷ຠïðèíöèïè ³
çì³ñò îñâ³òè òà ï³äãîòîâêè ôàõ³âö³â ç ðåàá³ë³òàö³¿,
à òàêîæ îö³íêó ðåàá³ë³òàö³éíî¿ êîìàíäè ³ ìóëüòè-
äèñöèïë³íàðíî¿ äîïîìîãè.
D.1. Äîñë³äæåííÿ ñèñòåì òà ïîñëóã ðåàá³ë³òàö³¿
D.1.1. Ïîë³òèêà ³ çàêîíîäàâñòâî â îõîðîíè çäîðî-
â’ÿ (âêëþ÷àþ÷è ìåäè÷íó òà ñîö³àëüíó ìîäåëü
îáìåæåííÿ æèòòºä³ÿëüíîñò³ ³ ðåàá³ë³òàö³¿)
194 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
D.1.2. Ñòðàòå㳿 çäîðîâ’ÿ ó Ô³çè÷í³é ³ Ðåàá³ë³-
òàö³éí³é Ìåäèöèí³
D.1.3. Îðãàí³çàö³ÿ ðåàá³ë³òàö³éíî¿ ñëóæáè
D.1.4. Åêîíîì³êà ðåàá³ë³òàö³¿
D.1.5. Äîñë³äæåííÿ ó÷àñò³ íà ð³âí³ ãðîìàäè
D.1.6. гçíå
D.2.Äîñë³äæåííÿ êîìïëåêñíèõ ðåàá³ë³òàö³éíèõ
âòðó÷àíü
D.2.1. Îö³íêà ðåàá³ë³òàö³éíî¿ ñëóæáè (âêëþ÷àþ÷è
ãîñòð³, ï³äãîñòð³ ïîñëóãè òà ðåàá³ë³òàö³éí³
ïîñëóãè â ãðîìàäè)
D.2.2. Îö³íêà ðåàá³ë³òàö³éíî¿ ïðîãðàìè (íàïð.
ðåàá³ë³òàö³ÿ â äîìàøí³õ óìîâàõ)
D.2.3. Îö³íþâàííÿ òåõíîëîã³é ðåàá³ë³òàö³¿ (íàïð.
òåëåðåàá³ë³òàö³ÿ)
D.2.4. Ñòðàòå㳿 ðåàá³ë³òàö³¿ äëÿ ñïåöèô³÷íèõ àñ-
ïåêò³â (âêëþ÷àþ÷è ñòðàòå㳿 ðåàá³ë³òàö³¿ äëÿ
êðà¿í, ùî ðîçâèâàþòüñÿ òà ðåàá³ë³òàö³ÿ ï³ñëÿ
ïðèðîäíèõ êàòàñòðîô)
D.2.5. Ïåðåäà÷à òåõíîëîã³é
D.2.6. Íàâ÷àííÿ ïàö³ºíòà òà ïðîêñ³-îñâ³òà
D.2.7. гçíå
D.3. Ïðîãðàìè ñîö³àëüíî¿ ³íòåãðàö³¿ òà ðåàá³ë³òàö³¿
äëÿ êîíêðåòíèõ ñîö³àëüíî-åêîíîì³÷íèõ ïîòðåá
D.3.1. Ïîë³òèêà òà óïðàâë³ííÿ â ðåàá³ë³òàö³¿, ùî
íàäàºòüñÿ â ãðîìàä³
D.3.2. Ïðîôåñ³éíà ðåàá³ë³òàö³ÿ
D.3.3. ϳäòðèìêà, äîïîìîãà òà íåçàëåæíå æèòòÿ
D.3.4. Êîìïåíñàö³¿ ïðè îáìåæåííÿõ æèòòºä³ÿëü-
íîñò³
D.3.5. гçíå
D.4. Îñâ³òà òà íàâ÷àííÿ â ðåàá³ë³òàö³¿
D.4.1. Äîäèïëîìíà ìåäè÷íà îñâ³òà
D.4.2. Íàâ÷àííÿ ñïåö³àë³ñòà
D.4.3. Áåçïåðåðâíà ìåäè÷íà îñâ³òà òà ïðîôåñ³éíèé
ðîçâèòîê
D.4.4. Òðåíóâàííÿ ç íàóêè òà äîñë³äæåíü
D.4.5. Òðåíóâàííÿ ³íøèõ ôàõ³âö³â ç ðåàá³ë³òàö³¿.
D.4.6. гçíå
D.5. Óïðàâë³ííÿ òà àäì³í³ñòðóâàííÿ ðåàá³ë³òàö³¿
D.5.1. Óïðàâë³ííÿ ðåàá³ë³òàö³éíèìè ñëóæáàìè
(âêëþ÷àþ÷è êîíöåïö³¿ ³íòåãðîâàíîãî äîãëÿäó
òà ïîñëóã)
D.5.2. Êåéñ-ìåíåäæìåíò
D.5.3. Ñòðóêòóðè òà ïðîöåñè â ðåàá³ë³òàö³éíèõ çàê-
ëàäàõ
D.5.4. гçíå
D.6. гçíå
E. Íàóêè ôóíêö³îíóâàííÿ ëþäèíè
Îïèñ: íàóêè ôóíêö³îíóâàííÿ ëþäèíè º ôóíäàìåí-
òàëüíèìè íàóêàìè ç êîìïëåêñíèìè ïåðñïåêòèâà-
¹2(2) *2018
 ÐÎÇÄ²Ë 10 – ÍÀÓÊÀ ÒÀ ÄÎÑ˲ÄÆÅÍÍß Ó ÔÐÌ: ÎÑÎÁËÈÂÎÑÒ² ÒÀ ÏÐÎÁËÅÌÈ

ìè, ìåòîþ ÿêèõ º ðîçóì³ííÿ ôóíêö³îíóâàííÿ ëþäè-
íè ³ âèçíà÷åííÿ ö³ëåé äëÿ êîìïëåêñíèõ âòðó÷àíü.
Å 1. Òåî𳿠³ ìîäåë³ ôóíêö³îíóâàííÿ
Å.2. Êëàñèô³êàö³ÿ ôóíêö³îíóâàííÿ (íàïð. áàçîâ³
íàáîðè ÌÊÔ, îíîâëåííÿ ³ ïåðåãëÿä ÌÊÔ)
Å.3. Âèì³ðþâàííÿ ôóíêö³îíóâàííÿ (íàïð. ïñèõî-
ìåòð³ÿ ³íñòðóìåíò³â îö³íþâàííÿ, ââåäåííÿ â
ä³þ êàòåãîð³é ÌÊÔ)
Å.4. Åï³äåì³îëîã³ÿ ôóíêö³îíóâàííÿ (ïîïóëÿö³éí³
ïîð³âíÿëüí³ äîñë³äæåííÿ ôóíêö³îíóâàííÿ ïðè ð³çíèõ
ñòàíàõ, êóëüòóðàõ ³ ÷àñó, íàïð. ïðè ïðàöåâëàøòó-
âàíí³ ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³)
Å.5. Îö³íêà âïëèâó ôóíêö³îíóâàííÿ (íàïð. ïðîãíî-
çóâàííÿ íàñë³äê³â ïîë³òèêè ³ çàêîíîäàâñòâà
ïðî ôóíêö³îíóâàííÿ)
Å.6. Åòè÷í³ ïèòàííÿ ³ ïðàâà ëþäèíè
E.7. Êóëüòóðí³ àñïåêòè îáìåæåíü æèòòºä³ÿëüíîñò³
òà ðåàá³ë³òàö³¿ (íàïð. êóëüòóðí³ âïëèâè, ñóñï³ëüí³
ñòàâëåííÿ, ðåë³ã³éí³ ïåðåêîíàííÿ)
E.8. гçíå

¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 195
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Á³ëà Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

(ÔÐM) â ªâðîï³.
Ðîçä³ë 11 – Âèêëèêè òà ïåðñïåêòèâè ìàéáóòíüîãî ÔÐÌ
Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè

ÐÅÇÞÌÅ
Ó êîíòåêñò³ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐÌ), öåé äîêóìåíò çàéìàºòüñÿ ìàéáóòí³ìè ïåðñïåê-
òèâàìè ÔÐÌ ó ªâðîï³ â³äïîâ³äíî äî ñó÷àñíîãî áà÷åííÿ ºâðîïåéñüêèõ îðãàí³â. Âñ³ ðîçä³ëè ï³äêðåñëþþòü âåëèê³ çì³íè,
ç ÿêèìè ñòèêàºòüñÿ ªâðîïà â ïëàí³ äåìîãðàô³¿, î÷³êóâàíî¿ òðèâàëîñò³ æèòòÿ, ïîêàçíèê³â âèæèâàíîñò³, òÿãàðÿ îáìåæåíü
æèòòºä³ÿëüíîñò³, çðîñòàííÿ ïîøèðåíîñò³ äîâãîòðèâàëèõ ñòàí³â çäîðîâ’ÿ, òåõíîëîã³÷íîãî ïðîãðåñó, à òàêîæ âèòðàò íà
îõîðîíó çäîðîâ’ÿ ³ çì³í â ñóñï³ëüñòâ³, çâàæàþ÷è íà ïîòðåáè â áëàãîïîëó÷÷³ òà ÿêîñò³ æèòòÿ ðàçîì ç³ çäîðîâ’ÿì. Âñ³ ö³
âèêëèêè ïîºäíóþòüñÿ ç³ ñïåöèô³êîþ ÔÐÌ, ÿêà º ìåäè÷íîþ ñïåö³àëüí³ñòþ, ùî çîñåðåäæóº óâàãó íà âñ³é ëþäèí³ òà ¿¿
ôóíêö³îíóâàíí³ ïðè ð³çíèõ ñòàíàõ çäîðîâ’ÿ, ç ìåòîþ çàáåçïå÷åííÿ íàéêðàùî¿ ó÷àñò³ øëÿõîì ïîêðàùåííÿ àêòèâíîñò³ òà
çìåíøåííÿ ïîðóøåíü. Ïðåäñòàâëåí³ ìîæëèâ³ íàñë³äêè öèõ çì³í ó ìàéáóòí³é åâîëþö³¿ êë³í³÷íî¿ ïðàêòèêè, ïîñëóã,
îñâ³òè òà äîñë³äæåíü ÔÐÌ. Êð³ì òîãî, ïðåäñòàâëåíî áà÷åííÿ ïðîãðåñó â îáëàñò³ ãàðìîí³çàö³¿ ðîçâèòêó ÔÐÌ â óñ³é
ªâðîï³ òà ìîæëèâèé âíåñîê ÔÐÌ ó ïëàíóâàííÿ ïîë³òèêè.
Ïîñèëàííÿ íà îðèã³íàëüíó âåðñ³þ ñòàòò³: European Physical and Rehabilitation Medicine Bodies Alliance. White Book on
Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 11. Challenges and perspectives for the future of PRM. Eur
J Phys Rehabil Med. 2018 Apr;54(2):311-321.
Ïîñèëàííÿ íà óêðà¿íñüêó âåðñ³þ ñòàòò³: Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Á³ëà
Êíèãà ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ÔÐM) â ªâðîï³. Ðîçä³ë 11. Âèêëèêè òà ïåðñïåêòèâè ìàéáóòíüîãî ÔÐÌ.
Óêðà¿íñüêèé æóðíàë ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè . 2018; 2(2) äîä. Ñ. 196–206.
Êëþ÷îâ³ ñëîâà: Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà, ªâðîïà, ïðîãíîçóâàííÿ, ìåäè÷í³ ïîñëóãè, îñâ³òà, äîñë³äæåííÿ.

Ââåäåííÿ êàºòüñÿ ªâðîïà â ïëàí³ äåìîãðàô³¿, î÷³êóâàíî¿ òðè-

Á³ëà êíèãà (ÁÊ) ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè (ÔÐÌ) ó ªâðîï³ ðîçðîáëåíà ÷îòèðìà
ªâðîïåéñüêèìè Îðãàíàìè ÔÐÌ ³ º äîâ³äíèêîì äëÿ
ë³êàð³â ÔÐÌ ó ªâðîï³. Âîíà ìຠê³ëüêà çíà÷åíü, ùî
âêëþ÷àþòü çàáåçïå÷åííÿ êîíñîë³äóþ÷î¿ ñèñòåìè
äëÿ ºâðîïåéñüêèõ êðà¿í, ³íôîðìóâàííÿ îñ³á, ùî óõ-
âàëþþòü ð³øåííÿ íà ºâðîïåéñüêîìó òà íàö³îíàëü-
íîìó ð³âíÿõ, ïðîïîíóâàííÿ íàâ÷àëüíèõ ìàòåð³àë³â
äëÿ ðåçèäåíò³â òà ë³êàð³â ÔÐÌ òà ³íôîðìóâàííÿ ïðî
ÔÐÌ ìåäè÷íî¿ ñï³ëüíîòè, ³íøèõ ôàõ³âö³â ðåàá³ë³òàö³¿
òà ãðîìàäñüêîñò³. ÁÊ íàãîëîøóº íà âàæëèâîñò³
ÔÐÌ, ÿêà º ïåðâèííîþ ìåäè÷íîþ ñïåö³àëüí³ñòþ.
Çì³ñò âêëþ÷àº: âèçíà÷åííÿ òà ïîíÿòòÿ ÔÐÌ, ÷îìó
ðåàá³ë³òàö³ÿ ïîòð³áíà îêðåìèì ëþäÿì ³ ñóñï³ëüñòâó,
îñíîâè ÔÐÌ, ³ñòîð³ÿ ñïåö³àëüíîñò³ ÔÐÌ, ñòðóêòó-
ðà ³ ä³ÿëüí³ñòü îðãàí³çàö³é ÔÐÌ â ªâðîï³, çíàííÿ ³
íàâè÷êè ë³êàð³â ÔÐÌ, ñôåðà êë³í³÷íèõ êîìïåòåíò-
íîñòåé ÔÐÌ, ì³ñöå ñïåö³àëüíîñò³ ÔÐÌ â ñèñòåì³
îõîðîíè çäîðîâ’ÿ ³ ñóñï³ëüñòâ³, îñâ³òà òà áåçïåðåð-
âíèé ïðîôåñ³éíèé ðîçâèòîê ë³êàð³â ÔÐÌ, îñîáëè-
âîñò³ òà ïðîáëåìè íàóêè òà äîñë³äæåíü â ÔÐÌ òà
ïðîáëåìè òà ïåðñïåêòèâè ìàéáóòíüîãî ÔÐÌ.
Ó öüîìó ðîçä³ë³ îñíîâíà óâàãà ïðèä³ëÿºòüñÿ
ìàéáóòí³ì ïåðñïåêòèâàì ÔÐÌ ó ªâðîï³ â³äïîâ³ä-
íî äî ñó÷àñíîãî áà÷åííÿ ºâðîïåéñüêèõ îðãàí³â. Âñ³
ðîçä³ëè ï³äêðåñëþþòü âåëèê³ çì³íè, ç ÿêèìè ñòè-
âàëîñò³ æèòòÿ, ïîêàçíèê³â âèæèâàíîñò³, òÿãàðÿ îá-
ìåæåííÿ æèòòºä³ÿëüíîñò³, çðîñòàííÿ ïîøèðåíîñò³
äîâãîòðèâàëèõ ñòàí³â çäîðîâ’ÿ, òåõíîëîã³÷íîãî
ïðîãðåñó, à òàêîæ âèòðàò íà îõîðîíó çäîðîâ’ÿ ³
çì³í â ñóñï³ëüñòâ³ ç òî÷êè çîðó ïîòðåá â áëàãîïî-
ëó÷÷³ òà ÿêîñò³ æèòòÿ ðàçîì ç³ çäîðîâ’ÿì. Âñ³ ö³
âèêëèêè ïîºäíóþòüñÿ ç³ ñïåöèô³êîþ ÔÐÌ, ÿêà º
ìåäè÷íîþ ñïåö³àëüí³ñòþ, ùî çîñåðåäæóº óâàãó íà
âñ³é ëþäèí³ òà ¿¿ ôóíêö³îíóâàíí³ ïðè ð³çíèõ ñòàíàõ
çäîðîâ’ÿ, ç ìåòîþ çàáåçïå÷åííÿ íàéêðàùî¿ ó÷àñò³
øëÿõîì ïîêðàùåííÿ àêòèâíîñò³ òà çìåíøåííÿ ïî-
ðóøåíü. Ìåòîþ öüîãî ðîçä³ëó º ïðåäñòàâëåííÿ
âïëèâó öèõ çì³í íà êë³í³÷íó ïðàêòèêó, ðîçâèòîê
ïîñëóã, îñâ³òè òà äîñë³äæåíü ÔÐÌ. Êð³ì òîãî,
ïðåäñòàâëåíî áà÷åííÿ ïðîãðåñó â îáëàñò³ ãàðìî-
í³çàö³¿ ðîçâèòêó ÔÐÌ â óñ³é ªâðîï³ òà ìîæëèâèé
âíåñîê ÔÐÌ ó ïëàíóâàííÿ ïîë³òèêè.
Ðîçâèòîê ïîñëóã ô³çè÷íî¿
òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
Íàâ³òü ÿêùî í³õòî íå çìîæå òî÷íî ïåðåäáà÷è-
òè ìàéáóòíº, äåÿê³ òåíäåíö³¿ äåìîãðàô³¿, åï³äåì³î-
ëî㳿 òà ñóñï³ëüíîãî ñòàâëåííÿ, éìîâ³ðíî, òðèâàòè-
ìóòü ³ íàñòóïí³ 10-30 ðîê³â. Îñü äåÿê³ ç íèõ:
– òðèâàë³ñòü æèòòÿ áóäå íàäàë³ çðîñòàòè, ³ ëþäè
ç äîâãîòðèâàëèìè ñòàíàìè çäîðîâ’ÿ, ùî ïðèçâî-

196 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018

äÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³ òà íàÿâíè-
ìè îáìåæåííÿìè æèòòºä³ÿëüíîñò³ áóäóòü æèòè
äîâøå. Äåÿê³ ïðîáëåìè ë³òíèõ ëþäåé, òàê³ ÿê
êâîë³ñòü, äåìåíö³ÿ òà òðóäíîù³ â ïåðåñóâàíí³,
ñàìîîáñëóãîâóâàíí³ òà ñï³ëêóâàíí³, áóäóòü çðî-
ñòàòè. Öå çá³ëüøèòü ïîòðåáó â ðåàá³ë³òàö³¿1;
– ÷åðåç ïðîãðåñ ó ë³êóâàíí³, âèæèâàííÿ ï³ñëÿ âàæ-
êèõ çàõâîðþâàíü (âêëþ÷àþ÷è ðàê) òà òðàâì ùå
á³ëüøå çá³ëüøèòüñÿ. Áàãàòî ç öèõ çàõâîðþâàíü
áóäóòü åâîëþö³îíóâàòè â õðîí³÷í³ ñòàíè çäîðî-
â’ÿ, îäíî÷àñíî áàãàòî ëþäåé, ùî âèæèëè ï³ñëÿ
çàõâîðþâàíü, áóäóòü çàçíàâàòè ïåâíèõ îáìå-
æåíü æèòòºä³ÿëüíîñò³: á³ëüø³ñòü ç íèõ áóäóòü
ïîòðåáóâàòè ðåàá³ë³òàö³¿;
– òàêîæ, íîâ³ ³íôåêö³éí³ çàõâîðþâàííÿ ìîæóòü
ïðèçâåñòè äî çá³ëüøåííÿ ïîòðåáè ó ðåàá³ë³òàö³¿
(îäíèì ç îñòàíí³õ ïðèêëàä³â º åï³äåì³ÿ â³ðóñó
dzêà);
– ìàéæå â óñ³õ ºâðîïåéñüêèõ êðà¿íàõ äåìîãðà-
ô³÷í³ çì³íè ñôîðìóþòü ïåâíèé òèñê íà ñîö³àëüí³
ñèñòåìè. Îäíèì ³ç íàñë³äê³â öüîãî áóäå ïîòðå-
áà ó òðèâàë³øîìó ðîáî÷îìó æèòò³. Îòæå, ïî-
òðåáà â ïðîôåñ³éí³é ðåàá³ë³òàö³¿ ìîæå òàêîæ
çá³ëüøèòèñü;
– ³íø³ ñîö³àëüí³ åâîëþö³¿, òàê³, ÿê çðîñòàþ÷à
íåð³âí³ñòü òà ðîçðèâ ó ñï³ââ³äíîøåíí³ áàãàò³/
á³äí³2,3, àáî ôóíêö³ÿ ñ³ìåé òà äîãëÿäà÷³â, çíà÷-
íîþ ì³ðîþ çì³íèòü êîíòåêñòóàëüí³ ôàêòîðè, ïî-
òðåáóþ÷è íîâèõ ð³øåíü äëÿ çìåíøåííÿ îáìå-
æåíü àêòèâíîñò³ òà äîñÿãíåííÿ íàéêðàùî¿
ìîæëèâî¿ ó÷àñò³;
– ïðîãðåñ ó ñôåð³ óïðàâë³ííÿ òåõíîëîã³ÿìè òà
öèôðîâèìè äàíèìè ðîçâèâàºòüñÿ ç íàäçâè÷àé-
íî âèñîêîþ øâèäê³ñòþ. Äåÿê³ ç öèõ òåõíîëîã³é
âæå âèêîðèñòîâóþòüñÿ â ðåàá³ë³òàö³¿, àëå öÿ
òåíäåíö³ÿ ïðèñêîðèòüñÿ ó íàéáëèæ÷³ ðîêè. ÔÐÌ
ïîâèííà äîëó÷èòèñü äî öüîãî ðîçâèòêó òà âçÿ-
òè ë³äåðñòâî ó ðîçðîáö³ òà âèêîðèñòàíí³ íîâèõ
òåõíîëîã³é äëÿ ïîêðàùåííÿ ôóíêö³îíóâàííÿ îñ³á
ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³;
– òðèâàë³ñòü íåçàëåæíîãî òà àêòèâíîãî æèòòÿ òà
ÿê³ñòü æèòòÿ íàñåëåííÿ òàêîæ áóäå íàäàë³ çðî-
ñòàòè. Öå çá³ëüøèòü ïîïèò íà ñêëàäí³ òà ³ííî-
âàö³éí³ ðåàá³ë³òàö³éí³ ïðîãðàìè òà ñòðàòå㳿;
– îñê³ëüêè âèòðàòè íà îõîðîíó çäîðîâ’ÿ ïðîäîâ-
æóâàòèìóòü çðîñòàòè, áóäå ïîòð³áíî âñå á³ëüøå
³ á³ëüøå, ùîá ë³êóâàííÿ ´ðóíòóâàëèñü íà äîêà-
çàõ òà äåìîíñòðóâàëî åêîíîì³÷íó åôåêòèâí³ñòü.
Òàêèì ÷èíîì, ïîòðåáà â íàóêîâèõ äîñë³äæåí-
íÿõ â ñôåð³ ÔÐÌ áóëå íàäàë³ çá³ëüøóâàòèñü;
– íàðåøò³, àëå íå ìåíø âàæëèâî, êðà¿íè ç íèçü-
êèì ³ íèæ÷å ñåðåäíüîãî ð³âíÿìè äîõîäó áóäóòü
ìàòè ï³äâèùåíèé ïîïèò íà ³ìïëåìåíòàö³þ ðåà-
á³ë³òàö³éíèõ ïîñëóã òà íàâ÷àííÿ ôàõ³âö³â ç ðåà-
á³ë³òàö³¿ (öå áóäå, çîêðåìà, ó êðà¿íàõ Àôðèêè
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 11 – ÂÈÊËÈÊÈ ÒÀ ÏÅÐÑÏÅÊÒÈÂÈ ÌÀÉÁÓÒÍÜÎÃÎ ÔÐÌ
ï³âäåíí³øå Ñàõàðè òà äåÿêèõ êðà¿íàõ ϳâäåííî-
Ñõ³äíî¿ À糿). ªâðîïåéñüêà ÔÐÌ áóäå ñòèêàòè-
ñÿ ç âèêëèêàìè ñïðèÿííÿ âèð³øåííþ ö³º¿ ïðîáëå-
ìè, ÿêà áóäå âïëèâàòè íà ãóìàí³òàðíèé ñòàí,
ðîçâèòîê òà ãðîìàäñüêå çäîðîâ’ÿ.
Ç öèõ ïðèêëàä³â ÿñíî, ùî ïîòðåáà â ðåàá³ë³òàö³¿
áóäå çá³ëüøóâàòèñÿ ó ìàéáóòíüîìó, òà ïåðåä íàìè
áàãàòî âèêëèê³â. ßê âæå áóëî ñêàçàíî, ðåàá³ë³òà-
ö³ÿ áóäå ñòðàòå㳺þ îõîðîíè çäîðîâ’ÿ ÕÕ² ñòî-
ë³òòÿ4. ßê³ íàñë³äêè äëÿ ÔÐÌ ìîæóòü áóòè ðåçóëü-
òàòîì âèùåçãàäàíèõ âèêëèê³â? Öå ïîòðåáóº
îáãîâîðåííÿ â óñ³õ ªâðîïåéñüêèõ îðãàíàõ ÔÐÌ òà
ðîçðîáêè ºâðîïåéñüêî¿ ñòðàòå㳿. Ïðîòå äåÿê³ ïóí-
êòè âæå ìîæóòü áóòè âèçíà÷åí³:
– Îñê³ëüêè ïîòðåáà â ë³êàðÿõ ÔÐÌ çðîñòàòèìå,
ìè ïîâèíí³ çàáåçïå÷èòè:
– äîñòàòí³é ïîòåíö³àë ðåçèäåíòóðè òà íàâ÷àëü-
íèõ ïðîãðàì ³ ïðèâàáëåííÿ ìîëîäèõ ë³êàð³â
äî êàð’ºðè â ÔÐÌ;
– äîñòàòíþ ê³ëüê³ñòü ë³êàð³â, ÿê³ íàâ÷àþòüñÿ
ÔÐÌ (öå, â îñíîâíîìó, º ïîë³òè÷íîþ ïðîáëå-
ìîþ);
– äîñòóïí³ñòü òà ïîâíó êâàë³ô³êàö³þ ôàõ³âö³â
ç ðåàá³ë³òàö³¿, ÿê³ ïîâèíí³ áóòè ÷àñòèíîþ
ðåàá³ë³òàö³éíî¿ êîìàíäè;
– Ìè ïîâèíí³ çàáåçïå÷èòè, ùîá ìàéáóòí³ ë³êàð³
ÔÐÌ âîëîä³ëè äîñòàòí³ìè íàâè÷êàìè ³ çä³áíîñ-
òÿìè äëÿ òðåíóâàííÿ ïàö³ºíò³â ç ñåðéîçíèìè ³
êîìïëåêñíèìè ïðîáëåìàìè íà âñ³õ åòàïàõ ³ íà
âñ³õ ð³âíÿõ îõîðîíè çäîðîâ’ÿ. Öå âêëþ÷àº:
– Ðåàá³ë³òàö³þ ë³òí³õ ëþäåé;
– Ðåàá³ë³òàö³þ âïðîäîâæ ãîñòðî¿ òà ðàííüî¿
ï³äãîñòðî¿ ôàç;
– «Âèñîêîÿê³ñíó» ðåàá³ë³òàö³þ äëÿ ïàö³ºíò³â ç³
ñêëàäíèìè ³ ñïåöèô³÷íèìè ïîòðåáàìè, òàêè-
ìè ÿê òðàíñïëàíòàö³ÿ îðãàí³â, ðåãåíåðàòèâ-
íà òåðàï³ÿ, ìíîæèííà òðàâìà, ñïèííîìîçêî-
âà òðàâìà, ñïåöèô³÷í³ òèïè çëîÿê³ñíèõ
ïóõëèí òà áàãàòî ³íøîãî;
– Çíàííÿ òà äîñâ³ä ñó÷àñíèõ òåõíîëîã³é ðå-
àá³ë³òàö³¿;
– Íàâè÷êè ó âèð³øåíí³ ñêëàäíèõ ïñèõîñîö³àëü-
íèõ ïðîáëåì
– Ïîòðåáóº îáãîâîðåííÿ íåîáõ³äí³ñòü àêðåäèòàö³¿
ð³çíèõ îáëàñòåé ÔÐÌ ó ìàéáóòíüîìó, òàêèõ ÿê
«Ðåàá³ë³òàö³ÿ äëÿ ë³òíèõ ëþäåé», «Ðåàá³ë³òàö³ÿ
â ãîñòðîìó ïåð³îä³», «Ðåàá³ë³òàö³ÿ áîëüîâîãî
ñèíäðîìó», «Ðåàá³ë³òàö³ÿ ÷åðåïíî-ìîçêîâî¿ òà
ñïèííîìîçêîâî¿ òðàâìè», «Ïðîôåñ³éíà ðåàá³ë³-
òàö³ÿ», «Ì’ÿçîâî-ñêåëåòíà ðåàá³ë³òàö³ÿ»,
«Êàðä³î-ðåñï³ðàòîðíà ðåàá³ë³òàö³ÿíÿ, «Ðåàá³ë³-
òàö³ÿ ðàêó» òà ³íø³;
– Äîñë³äíèöüêà ä³ÿëüí³ñòü ïîâèííà ñóòòºâî ï³äâè-
ùóâàòèñÿ ³ ïîë³ïøóâàòèñÿ, âêëþ÷àþ÷è ïàòî-
ô³ç³îëîã³þ ñòàí³â çäîðîâ’ÿ, ùî ïðèçâîäÿòü äî
197
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
îáìåæåíü æèòòºä³ÿëüíîñò³, ìåõàí³çì ðåàá³ë³òà-
ö³éíèõ ³íòåðâåíö³é, äîïîì³æí³ òåõíîëî㳿, ðåçóëü-
òàòè ðåàá³ë³òàö³éíèõ ïðîãðàì;
– Âñåðåäèí³ ñï³ëüíîòè ÔÐÌ ïîâèíí³ áóòè ðîçðîá-
ëåí³ ñòðàòå㳿 àäåêâàòíîãî ðåàãóâàííÿ íà âèê-
ëèêè ñóñï³ëüñòâà â ªâðîï³ òà ñóñ³äí³õ ðåã³îíàõ,
íàïð. â³äïîâ³äü íà äåìîãðàô³÷í³ çì³íè, çðóøåííÿ
î÷³êóâàíü ñóñï³ëüñòâà, íåîáõ³äí³ñòü á³ëüøî¿
ðåàá³ë³òàö³¿ â êðà¿íàõ ç íèçüêèì ð³âíåì ðåñóðñ³â
òîùî.
Ïîòð³áíî âðàõîâóâàòè òàêîæ ³ ³íøèé âèêëèê (öå
òàêîæ ìîæå áóòè ìîæëèâ³ñòþ). ²íø³ ôàõ³âö³ îõî-
ðîíè çäîðîâ’ÿ ï³äâèùóþòü ñâî¿ çíàííÿ òà íàâè÷êè,
òà ìàþòü òåíäåíö³þ ïðîâîäèòè ðåàá³ë³òàö³þ ñàìî-
ñò³éíî òà / àáî íàìàãàòèñÿ êåðóâàòè ðåàá³ë³òàö³é-
íîþ êîìàíäîþ. Ó äåÿêèõ êðà¿íàõ ïðîôåñ³éí³ ãðó-
ïè òåðàïåâò³â áîðþòüñÿ ç ë³êàðÿìè ÔÐÌ òà
âèìàãàþòü ï³êëóâàííÿ çà ïîâíèì ïðîöåñîì ðåàá³-
ë³òàö³¿. Ó áàãàòüîõ ³íøèõ êðà¿íàõ ³ñíóº ãàðíå ñï³âðî-
á³òíèöòâî ç ïîâàãîþ äî çàâäàíü òà äîñâ³äó îäèí
îäíîãî äëÿ ðîáîòè â êîìàíä³. Çâè÷àéíî, íå ìîæå
áóòè ñïðèéíÿòèì, ÿêùî îäíà ïðîôåñ³ÿ â³äêèäàº
ðîëü ³íøî¿, òîìó, îñîáëèâî â ðåàá³ë³òàö³¿, ãîëîâíèì
ïðèíöèïîì ïîâèííà áóòè ñï³ëüíà ìóëüòè-ïðîôå-
ñ³éíà êîìàíäíà ðîáîòà ï³ä êåð³âíèöòâîì ë³êàð³â
ÔÐÌ5. Òðåáà â³òàòè, ÿêùî áóäü-ÿêà ïðîôåñ³ÿ îõî-
ðîíè çäîðîâ’ÿ ìຠíàì³ð íàëåæíèì ÷èíîì ñï³âïðà-
öþâàòè äëÿ äîïîìîãè îñîáàì ç îáìåæåííÿìè æèò-
òºä³ÿëüíîñò³ àáî ç³ ñòàíàìè, ùî îáìåæóþòü
æèòòºä³ÿëüí³ñòü, áåðó÷è ó÷àñòü ó ìóëüòè-ïðî-
ôåñ³éí³é êîìàíä³ ï³ä êåð³âíèöòâîì ë³êàðÿ ÔÐÌ.
Òàêîæ â³òàþòüñÿ óñ³ ä³éñí³ âíåñêè ç íàóêîâèõ äî-
ñë³äæåíü â³ä áóäü-ÿêîãî ôàõ³âöÿ ç ðåàá³ë³òàö³¿, êîëè
âîíè ³íòåãðîâàí³ â ìóëüòè-ïðîôåñ³éíó êîìàíäíó
ðîáîòó, âêëþ÷àþ÷è ë³êàðÿ ÔÐÌ. Ùå îäí³ºþ âàæ-
ëèâîþ ïðîáëåìîþ ìîæå ñòàòè òèñê ç áîêó íàö³î-
íàëüíèõ ñèñòåì îõîðîíè çäîðîâ’ÿ, àëå òàêîæ
ïàö³ºíò³â, ùîá êðàùå ñïðàâëÿòèñÿ ç òÿãàðåì îáìå-
æåíü æèòòºä³ÿëüíîñò³ òà ñòàð³ííÿ, ùî ìîæå ïðè-
çâåñòè äî ñòâîðåííÿ íîâèõ çàêëàä³â ÔÐÌ â ðóêàõ
ë³êàð³â, ÿê³ íå º ë³êàðÿìè ÔÐÌ, íàïð. ³íøèõ
ôàõ³âö³â, ÿê³ âõîäÿòü äî ñôåðè ÔÐÌ. Öå, ïî ñóò³,
ìîæå òàêîæ áóòè ðåçóëüòàòîì íåñòà÷³ ðîáî÷î¿
ñèëè ë³êàð³â ÔÐÌ ó çâ’ÿçêó ç ï³äâèùåííÿì ïîòðåá.
Óðÿäàì ³ ì³í³ñòåðñòâàì îõîðîíè çäîðîâ’ÿ ñë³ä
ñòâîðþâàòè àáî ðîçâèâàòè ñïåö³àëüí³ñòü ÔÐÌ â
êðà¿íàõ, äå âîíà ùå íå ³ñíóº, àáî ë³êàð³â ÔÐÌ äóæå
ìàëî; âîíè ïîâèíí³ ñòâîðèòè óìîâè äëÿ íàâ÷àííÿ
ìåäè÷íèõ ñïåö³àë³ñò³â ç ÔÐÌ â ñâî¿õ êðà¿íàõ (àáî
íà ðàíí³é ñòà䳿, ç íàâ÷àííÿì â ³íøèõ êðà¿íàõ ç
âèçíàíèì äîñâ³äîì ³ ïðèäàòí³ñòþ äëÿ íàâ÷àííÿ).
Íåîáõ³äíî çàîõî÷óâàòè òà ñïðèÿòè â³ëüíîìó ïåðå-
ñóâàííþ ïðîôåñ³îíàë³â, ó öüîìó âèïàäêó – ë³êàð³â
ÔÐÌ, ì³æ äåðæàâàìè ªâðîïåéñüêîãî Ñîþçó.
198 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Ó ö³ëîìó, çäàºòüñÿ î÷åâèäíèì, ùî ñïåö³àëüí³ñòü
Ô³çè÷íà òà Ðåàá³ë³òàö³éíà Ìåäèöèíà ïîâèííà äóæå
³íòåíñèâíî ïðàöþâàòè íàä âèð³øåííÿì ìàéáóòí³õ
ïðîáëåì òà áðàòè â³äïîâ³äàëüí³ñòü çà ñóñï³ëüñòâî,
ñèñòåìè îõîðîíè çäîðîâ’ÿ òà îñ³á, ÿê³ ñòðàæäàþòü
íà âàæê³ òà/àáî äîâãîòðèâàë³ ñòàíè çäîðîâ’ÿ,
çàçíàþ÷è îáìåæåíü æèòòºä³ÿëüíîñò³.
Îñâ³òà
Çàðàç ìè ñòèêàºìîñÿ ç âðàæàþ÷èì çá³ëüøåí-
íÿì î÷³êóâàíî¿ òðèâàëîñò³ æèòòÿ ÿê â êðà¿íàõ ç
âèñîêèì, òàê ³ íèçüêèì àáî ñåðåäí³ì ð³âíåì äîõî-
äó. Ñòàð³ííÿ íàñåëåííÿ ðàçîì ³ç çíèæåííÿì ñìåðò-
íîñò³ ï³ñëÿ âàæêèõ òðàâì òà ãîñòðèõ çàõâîðþâàíü
ïðèçâåäå äî çá³ëüøåííÿ ïîòðåáè â ðåàá³ë³òàö³éíèõ
ñëóæáàõ ó âñ³õ ºâðîïåéñüêèõ êðà¿íàõ, äå î÷³êóºòü-
ñÿ òàêîæ âèñîêèé ð³âåíü æèòòÿ. Á³ëüø òîãî, ðîç-
âèòîê òåõíîëîã³é ñïðèÿº øèðîêîìó äîñòóïó äî
³íôîðìàö³¿, ùî ñïðÿìîâóº ëþäåé ç îáìåæåííÿìè
æèòòºä³ÿëüíîñò³ âèìàãàòè íàäàííÿ íàëåæíî¿ ðåà-
á³ë³òàö³¿, çàáåçïå÷åííÿ ð³âíîãî äîñòóïó äî ë³êàðåíü
³ ãðîìàäñüêèõ óñòàíîâ äëÿ â³äïîâ³äàëüíî¿ äîïîìîãè
ñâî¿ì õðîí³÷íèì ïðîáëåìàì ç³ çäîðîâ’ÿì. Îñòàííº,
àëå íå ìåíø âàæëèâå, äâà îñòàíí³õ äåñÿòèë³òòÿ
ïðîäåìîíñòðóâàëè åêñïîíåíö³àëüíèé ðîçâèòîê äî-
ïîì³æíèõ òà ³íôîðìàö³éíèõ òåõíîëîã³é, àâòîìàòè-
çàö³¿ òà ³íôîðìàòèçàö³¿ äîìàøí³õ ãîñïîäàðñòâ, á³î-
³íæåíåð³¿, ðîáîòîòåõí³êè òà òåëåðåàá³ë³òàö³³.  òîé
æå ÷àñ ðîçêâ³òàþòü çíàííÿ ïðî íåéðîíàëüí³ îñíî-
âè ðóõîâîãî êîíòðîëþ, ïðèéíÿòòÿ ð³øåíü ³ ôóíêö³î-
íàëüíîãî â³äíîâëåííÿ: î÷³êóºòüñÿ, ùî ì³æäèñöèï-
ë³íàðí³ äîñë³äæåííÿ, ÿê³ îá’ºäíóþòü íåéðîíàóêè ç
³íæåíåðíèì ïîòåíö³àëîì, çàáåçïå÷àòü ôàõ³âöÿì
ðåàá³ë³òàö³¿ øèðîêèé ñïåêòð ³ííîâàö³éíèõ ä³àãíîñ-
òè÷íèõ òà òåðàïåâòè÷íèõ ³íñòðóìåíò³â.  ðåçóëü-
òàò³ î÷³êóºòüñÿ çðîñòàííÿ ð³âíÿ ðåàá³ë³òàö³éíî¿
äîïîìîãè (âêëþ÷íî ³ç çàáåçïå÷åííÿì ÿêîñò³ òà
³íòåðâåíö³ÿìè, ùî ´ðóíòóþòüñÿ íà íàóêîâèõ äàíèõ)
òà îñâ³òè ë³êàð³â ÔÐÌ. ϳñëÿäèïëîìíå íàâ÷àííÿ ç
ÔÐÌ ïîâèííî ñòèìóëþâàòè ìàéáóòí³õ ôàõ³âö³â
ïðèéìàòè ñóâîðèé íàóêîâèé ï³äõ³ä äî êë³í³÷íî¿
ïðàêòèêè òà ðîçâèâàòè ¿õ ñõèëüí³ñòü äî áåçïåðåð-
âíîãî íàâ÷àííÿ òà ñàìîîö³íêè. Êð³ì òîãî, äëÿ çà-
äîâîëåííÿ çðîñòàþ÷îãî ïîïèòó íà ïîñëóãè, ë³êàð³
ÔÐÌ ïîâèíí³ áóòè çîáîâ’ÿçàíèìè îö³íþâàòè òà
çàáåçïå÷óâàòè ñòàë³ñòü øëÿõ³â äîïîìîãè òà ïðî-
òîêîë³â âòðó÷àííÿ â óìîâàõ ì³öíîãî àëüÿíñó ç
ïîë³òèêàìè, ïðè òîìó íå â³äìîâëÿþ÷èñü â³ä ñïðà-
âåäëèâîñò³. Çá³ëüøåííÿ öèðêóëÿö³¿ ãðîìàäÿí ªÑ
çà ìåæàìè íàö³îíàëüíèõ êîðäîí³â ñòàíå ùå îä-
íèì ñòèìóëîì äëÿ íåîáõ³äíîñò³ ãàðìîí³çàö³¿
íàâ÷àííÿ ÔÐÌ ³ íàäàííÿ ðåàá³ë³òàö³¿ ïî âñ³õ ºâðî-
ïåéñüêèõ êðà¿íàõ. Ó ï³äñóìêó, ö³ åâîëþö³¿ âèìà-
¹2(2) *2018

ãàòèìóòü ç³òêíåííÿ íà äâîõ ð³âíÿõ: äîäèïëîìíå
íàâ÷àííÿ äëÿ çá³ëüøåííÿ îá³çíàíîñò³ ìàéáóòí³õ
ë³êàð³â ïðî ÔÐÌ; ï³äãîòîâêà ñïåö³àë³ñò³â – ë³êàð³â
ÔÐÌ, ç îäíîãî áîêó, ç ìåòîþ çá³ëüøåííÿ ¿õ
ê³ëüêîñò³ ç îãëÿäó íà çðîñòàþ÷³ ïîòðåáè, ç ³íøîãî
– ï³äâèùåííÿ ¿õ êîìïåòåíòíîñòåé òà ñïðîìîæíîñò³
óïðàâëÿòè á³ëüøîþ ê³ëüê³ñòþ ïàö³ºíò³â ³ç çìåí-
øåííÿì ðåñóðñ³â (âèêîðèñòàííÿ òåõíîëîã³é, à
òàêîæ ïðèéíÿòòÿ íàéêðàùèõ ïðàêòèê íà ï³äñòàâ³
åôåêòèâíîñò³, ïðîäóêòèâíîñò³, à òàêîæ ðåçóëü
òàòèâíîñò³). Ö³ ïðîáëåìè áóäóòü âèð³øóâàòèñÿ
çàâäÿêè ä³ÿì Ðàäè ªÑÌÑ-ÔÐÌ ç ¿¿ âíåñêó ó âèç-
íà÷åííÿ îñíîâíèõ íàâ÷àëüíèõ ïðîãðàì äëÿ äîäèï-
ëîìíîãî íàâ÷àííÿ òà ï³äãîòîâêè ñïåö³àë³ñò³â.
Äîñë³äæåííÿ
Ãîâîðèòè ïðî ìàéáóòíº çàâæäè º âåëèêîþ ïðî-
áëåìîþ. Á³ëüø òîãî, êîëè çàëó÷åí³ äîñë³äæåííÿ,
³ñíóº ùå îäèí ôàêòîð, êð³ì íåïåðåäáà÷óâàíîñò³
ëþäñüêèõ ïîä³é: íåïåðåäáà÷óâàí³ñòü äîñë³äíèê³â
³ øëÿõ³â çðîñòàííÿ çíàíü, ÿê³ ð³äêî ìîæóòü áóòè
êåðîâàíèìè ççîâí³. Ïðîòå, â ÔÐÌ º âèçíà÷åí³ñòü:
äîñë³äæåííÿ íåóõèëüíî çðîñòàþòü6, ³ öå ïðèçâåäå
äî âåëèêèõ çì³í â íàø³é ïåðñïåêòèâ³. Ïîñò³éíî çðî-
ñòຠøâèäê³ñòü çàãàëüíèõ çíàíü ïðî ëþäñüêó ³ñòî-
òó: öå îçíà÷àº, ùî ìàéáóòíº äîñë³äæåíü ïðèéäå ùå
øâèäøå, í³æ çàçâè÷àé î÷³êóâàëîñÿ. Ó öüîìó
ðîçä³ë³, çàì³ñòü òîãî, ùîá ðîáèòè áóäü-ÿêå ðåàëü-
íå ïîïåðåäíº áà÷åííÿ, ìè áóäåìî ðîçãëÿäàòè çà-
ãàëüí³ ñöåíà𳿠ñêëàäíèõ äîñë³äæåíü, à òàêîæ ¿õ
â³äïîâ³äí³ ïîòðåáè. Çà çàãàëüíèì ñöåíàð³ºì ìè
ñòèêàºìîñÿ ç ïåð³îäîì ñêîðî÷åííÿ ðåñóðñ³â. Áåç-
ïåðåðâíå âäîñêîíàëåííÿ ìåäèöèíè çóìîâèëî çðî-
ñòàííÿ òåìï³â âèæèâàííÿ, ùî ïðèçâåëî äî ñòàð³ííÿ
íàñåëåííÿ òà çá³ëüøåííÿ îáìåæåíü æèòòºä³ÿëü-
íîñò³ òà õðîí³÷íèõ ñòàí³â. Íà æàëü, âñ³ ñèñòåìè
îõîðîíè çäîðîâ’ÿ â ªâðîï³ äîñÿãëè òîãî, ùî ââà-
æàºòüñÿ ìàêñèìàëüíîþ ìîæëèâ³ñòþ ïîãëèíàííÿ
ðåñóðñ³â (â³ä 7% äî 10% âàëîâèõ äîõîä³â êðà¿íè),
³ òîìó ñë³ä çîñåðåäèòè óâàãó íà òîìó, ÿê ðîáèòè ç
ìåíøèìè âèòðàòàìè ò³ æ ñàì³ (àáî ùå êðàù³) ïðî-
öåäóðè. Øâèäêèé ðîçâèòîê ìîëåêóëÿðíî-ãåíåòè÷-
íèõ äîñë³äæåíü äîçâîëèòü âèÿâèòè ïåðåäóìîâè äëÿ
ð³çíèõ ðîçëàä³â ç çíèæåíîþ ôóíêö³ºþ, äëÿ ³íäèâ³-
äóàëüíèõ çä³áíîñòåé äëÿ ðåàá³ë³òàö³¿ òà ï³äâèùåííÿ
ð³âíÿ çíàíü ïðî íåéðîíàëüíó ïëàñòè÷í³ñòü. Öå
ìàòèìå âïëèâ íà ³íø³ ÷àñòèíè ñïåêòðó ÌÊÔ, ³ öå
ñïîíóêຠÔÐÌ ñòàòè àêòèâíîþ ÷àñòèíîþ òðàíñ-
ëÿö³éíèõ äîñë³äæåíü. ²íøèé ö³êàâèé ìîìåíò – öå
ïîñòóïîâå çá³ëüøåííÿ òåõíîëîã³é. Ìàáóòü, â ìå-
äèöèí³ ìè ñòèêàºìîñÿ ç òèì æå ïðîöåñîì, ç ÿêèì
ñòèêàëîñÿ ïðîìèñëîâå âèðîáíèöòâî ïîíàä ñòîë³òòÿ
òîìó: òåõíîëîã³ÿ, ñõîæå, äîçâîëÿº çá³ëüøèòè íàø³
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 11 – ÂÈÊËÈÊÈ ÒÀ ÏÅÐÑÏÅÊÒÈÂÈ ÌÀÉÁÓÒÍÜÎÃÎ ÔÐÌ
ðåçóëüòàòè, à â ÔÐÌ öå â³äáóâàºòüñÿ ãîëîâíèì ÷è-
íîì çà äîïîìîãîþ ðîáîòîòåõí³êè òà ïðîòåçóâàí-
íÿ / îðòåçóâàííÿ, àëå òàêîæ çà äîïîìîãîþ â³ðòó-
àëüíî¿ ðåàëüíîñò³ ³ ³ãðîâèõ òåðàï³é. Ùå îäíà ÷³òêà
ïðîáëåìà ñó÷àñíèõ ºâðîïåéñüêèõ ñóñï³ëüñòâ – öå
ïðîãðåñèâíèé ðóõ ìåäè÷íèõ ïîòðåá ç ñåðåäèíè
ë³êàðåíü íàçîâí³: ëþäè õî÷óòü çàëèøàòèñÿ âäîìà
³ ââàæàþòü çà êðàùå ë³êóâàòèñÿ òàì, çðîñòຠõðî-
í³çàö³ÿ, òà ë³êàðí³ äîðîãî êîøòóþòü. Ó òîé æå ÷àñ,
òåëåìåäèöèíà çðîñòຠó âñ³õ îáëàñòÿõ ìåäèöèíè.
Âñ³ ö³ ñèòóàö³¿ êèäàþòü çíà÷íèé âèêëèê ÔÐÌ òà ¿¿
äîñë³äæåííÿì. Öå ÷³òêî ìîæëèâî ïîºäíóâàòè ç íå-
îáõ³äí³ñòþ çá³ëüøåííÿ ðåçóëüòàò³â, îð³ºíòîâàíèõ
íà ïåðñîíó, ÿê³ º íàéá³ëüø çíà÷óùèìè äëÿ íàøèõ
ïàö³ºíò³â òà ñóñï³ëüñòâ. Ùå îäíèì âàæëèâèì âèê-
ëèêîì º íåîáõ³äí³ñòü çì³íè ðîçïîä³ëó ô³íàíñóâàí-
íÿ, îñê³ëüêè íèí³øíº ïîâí³ñòþ çàñíîâàíå íà ñïåö³-
àëüíîñòÿõ ç àíàòî쳿 / ôóíêö³¿ îðãàí³çìó7. Ðóòèííà
ðîáîòà ÔÐÌ çíà÷íî çì³íþºòüñÿ. Õî÷à âïðîâàä-
æåííÿ ãîñòðî¿ ôàçè âæå äîáðå çàðåêîìåíäóâàëî
ñåáå, íîâ³ ôàçè âèâ÷àþòüñÿ ³ âäîñêîíàëþþòüñÿ,
òàê³, ÿê ïðå-àá³ë³òàö³ÿ8 òà / àáî ï³äòðèìêà àáî ïîñò-
ðåàá³ë³òàö³ÿ. Öå êèäຠâèêëèê óñ³é îðãàí³çàö³¿ ÔÐÌ,
ÿêà, éìîâ³ðíî, ïîâèííà òðàíñôîðìóâàòèñÿ â òðàíñ-
âåðçàëüíå â³ää³ëåííÿ, âêëþ÷àþ÷è âñ³õ ë³êàð³â ÔÐÌ
³ ôàõ³âö³â ç ðåàá³ë³òàö³¿, çàäëÿ äîïîìîãè ïàö³ºíòàì
ïðàâèëüíî ïåðåì³ùàòèñÿ ïðîòÿãîì ð³çíèõ ôàç:
³íñóëüòí³ áëîêè àáî áëîêè ñïèííî-ìîçêîâî¿ òðàâ-
ìè âæå áóëè îïèñàí³, àëå ïðîáëåìà º çàãàëüíîþ
äëÿ âñ³õ ïàòîëîã³é, à íå ò³ëüêè öèõ äâîõ. Ùå îäíà
ïðîáëåìà ïîëÿãຠâ ïîë³ïøåíí³ ÿê êë³í³÷íèõ, òàê ³
îðãàí³çàö³éíèõ êîìïåòåíòíîñòåé ôàõ³âö³â ç ðåàá³-
ë³òàö³¿, ÿê³ ïîâ’ÿçàí³ ç íàøîþ ôàêòè÷íîþ ïðîôå-
ñ³éíîþ ïîçèö³ºþ ³ ðîçâèâàþòü ¿¿. Ïðîáëåìà êëàñè-
ô³êàö³é (ÌÊÔ, àëå íå ò³ëüêè) òà ðå³ìáóðñàö³¿
ë³êóâàííÿ ÔÐÌ â óñüîìó ñâ³ò³ çàëèøàºòüñÿ àêòó-
àëüíîþ ³ íå º âèð³øåíîþ. ̳ñöå ÔÐÌ ó çàãàëüí³é
êàðòèí³ ñèñòåìè çäîðîâ’ÿ ñòຠâñå á³ëüø ÷³òêèì.
Âñ³ ö³ âèêëèêè â êîíòåêñò³ ÔÐÌ ïîòðåáóþòü êîí-
êðåòíèõ äîñë³äæåíü. Àëå äîñë³äæåííÿ ïðî îðãàí³-
çàö³þ, ç îäíîãî áîêó, º á³ëüø ñêëàäíèìè, à ç ³íøî-
ãî – ìåíø êîðèñíèé ç òî÷êè çîðó ³ìïàêò-ôàêòîðó.
Ô³íàíñóâàííÿ, îòæå, îòðèìàòè ñêëàäí³øå, àëå, òèì
íå ìåíø, öå òåðì³íîâî íåîáõ³äíî. Ó çàãàëüíîìó
äîñë³äíèöüêîìó ñöåíà𳿠³ñíóþòü ïåâí³ ÷³òê³ òåí-
äåíö³¿. Äîñë³äæåííÿ íèæíüîãî ð³âíÿ çàëèøàþòüñÿ
äóæå ïðàêòè÷íèìè, àëå äîêàçîâà ìåäèöèíà ÷³òêî
ïðîäåìîíñòðóâàëà âàæëèâ³ñòü çàïóñêó ðàíäîì³çî-
âàíèõ êîíòðîëüîâàíèõ äîñë³äæåíü (ÐÊÄ). Ó òîé æå
÷àñ çðîñòàþòü âàæëèâ³ñòü êë³í³÷íîãî äîñâ³äó ³ óïî-
äîáàíü ïàö³ºíò³â, ùî ïîâ’ÿçàíî ³ç çàñòîñóâàííÿì
íîâèõ ìåòîä³â ÿê³ñíèõ äîñë³äæåíü, â òîìó ÷èñë³
Narrative Medicine‡. Òðàíñëÿö³éí³ äîñë³äæåííÿ äëÿ
ïîøóêó êîðåëÿö³é ì³æ ìîëåêóëÿðíèìè ðåçóëüòàòà-
199
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
ìè ³ ôóíêö³ºþ, àêòèâí³ñòþ òà ó÷àñòþ ñòàþòü âñå
á³ëüø âàæëèâèìè. Ó ôàðìàêîëî㳿, ùîá ìàòè ìîæ-
ëèâ³ñòü çíàéòè íàâ³òü íåâåëèê³ çì³íè, ùî âèíèêà-
þòü âíàñë³äîê ë³êóâàííÿ, ÐÊÄ çàðàç çàëó÷àþòü
òèñÿ÷³ ïàö³ºíò³â: öå âèìàãຠñòâîðåííÿ âåëèêèõ
ìåðåæ, àëå òàêîæ ³ âåëèêèõ ãðîøåé äëÿ ïðîâåäåí-
íÿ äîñë³äæåíü.  ðàìêàõ ö³º¿ æå òåíäåíö³¿ ñïîñòå-
ð³ãàºòüñÿ çá³ëüøåííÿ ïðîäóêóâàííÿ ìåòààíàë³ç³â ³
ìåòàäîñë³äæåíü ç³ ñòâîðåííÿì âåëèêèõ áàç äàíèõ
³ çàêëèêîì ùîäî äîñòóïó äî â³äêðèòèõ äàíèõ. Òà-
êîæ çðîñòຠñòâîðåííÿ ðåã³ñòð³â ³ ðîçâèòîê ñïî-
ñòåðåæíèõ äîñë³äæåíü, áàçîâàíèõ íà öèõ êë³í³÷íèõ
áàçàõ äàíèõ: ð³çíèöÿ â³ä ÐÊÄ ïîëÿãຠâ òîìó, ùî
âîíè ïðîïîíóþòü ñâ³òó ðåàëüíó êë³í³÷íó ïîâñÿêäåí-
íó ³íôîðìàö³þ, ÿêà ³íîä³ ðàçþ÷å â³äð³çíÿºòüñÿ â³ä
ðåçóëüòàò³â, îòðèìàíèõ â ðåçóëüòàò³ åêñïåðèìåí-
òàëüíèõ äîñë³äæåíü, ÿê³, çà âèçíà÷åííÿì, ñïîñòå-
ð³ãàþòü äóæå ñïåöèô³÷í³ ³ äîáðå â³ä³áðàí³ ïîïó-
ëÿö³¿. Êîíöåïö³ÿ àíàë³çó âåëèêèõ äàíèõ
çàñòîñîâóºòüñÿ äî êë³í³ê ³ âñ³õ öèõ áàç äàíèõ. Ó
ÔÐÌ ìè äàëåê³ â³ä öèõ íàñë³äê³â, àëå ìè â òîé æå
÷àñ âñåðåäèí³ íèõ. Ìåðåæ³, áàçè äàíèõ, â³äêðèò³
äàí³ – öå ïðîáëåìè, ç ÿêèìè äîâîäèòüñÿ ñòèêàòè-
ñÿ. Ó âñÿêîìó ðàç³, ìè òàêîæ íå ìîæåìî ³ãíîðó-
âàòè òå, ùî ìè âñå ùå ñïîñòåð³ãàºìî, ÷è º ó ïåâ-
íèõ ìåòîä³â âòðó÷àííÿ áóäü-ÿêà åôåêòèâí³ñòü, òà
öå ìîæå áóòè äîñÿãíóòî òàêîæ ïðè ïðîâåäåíí³
äîñë³äæåíü çà ó÷àñòþ ñêîðî÷åíèõ ïîïóëÿö³é; íå
ìîæíà ³ãíîðóâàòè é òå, ùî íàø³ ïàö³ºíòè ìàéæå
çàâæäè ìàþòü áàãàòî ñóïóòí³õ çàõâîðþâàíü, ³ öå
ðîáèòü ñïîñòåðåæí³ äîñë³äæåííÿ òà ðåã³ñòðè äóæå
ö³êàâèìè äëÿ íàñ. Âñ³ ö³ äîñë³äíèöüê³ âèêëèêè ìî-
æóòü ñòàòè ïðèâîäîì äëÿ çðîñòàííÿ. Îäíî÷àñíî
ìè íå ìîæåìî ³ãíîðóâàòè, ùî íà çàãàëüíó êàðòèíó
âïëèâຠòå, ÿê äîñë³äæåííÿ ô³íàíñóþòüñÿ: ùîá
óíèêíóòè âèêëþ÷åííÿ, ìè ïîâèíí³ â áóäü-ÿêîìó
âèïàäêó â³äïîâ³äàòè ö³é çàãàëüí³é êàðòèí³. Íàðåøò³,
ñöåíàð³é äîñë³äæåííÿ ÔÐÌ. Ôóíêö³îíàëüíå îö³íþ-
âàííÿ òà îö³íêà ðåçóëüòàò³â º êëþ÷îâèìè ôàêòî-
ðàìè, ÿê³ ùå íåäîñòàòíüî ðîçâèíåí³: ó íàñ çàðàç º
äåÿê³ ³íñòðóìåíòè, àëå øëÿõ âñå ùå º äîâãèì.
Á³ëüø òîãî, òåõíîëîã³ÿ äîïîìàãຠâñå á³ëüøå, àëå
âñå öå ùå ïîòðåáóº íàáóâàííÿ çàãàëüíî¿ êë³í³÷íî¿
çíà÷óùîñò³. Ðîçóì³ííÿ òîãî, ùî òàêå ÔÐÌ9, çìó-
øóº íàñ ðóõàòèñÿ òàêîæ âñåðåäèíó òàê çâàíèõ ãó-
‡
ðåä. – Narrative Medicine çì³öíþº êë³í³÷íó ïðàêòèêó ç âèêîðèñ-
òàííÿì ðîçìîâíî¿ êîìïåòåíòíîñò³ ðîçï³çíàâàòè, ïîãëèíàòè, ìå-
òàáîë³çóâàòè, ³íòåðïðåòóâàòè ³ ðóõàòèñü ç ³ñòîð³ÿìè õâîðîáè.
Çàâäÿêè òðåí³íãó ç îïèòóâàííÿ, ïðîãðàìà Narrative Medicine äî-
ïîìàãຠë³êàðÿì, ìåäè÷íèì ñåñòðàì, ñîö³àëüíèì ïðàö³âíèêàì,
ôàõ³âöÿì ïñèõ³÷íîãî çäîðîâ‘ÿ, êàïåëàíàì, íàóêîâöÿì òà âñ³ì,
õòî çàö³êàâëåíèé ó ïåðåòèí³ ðîçïîâ³ä³ òà ìåäèöèíè, ï³äâèùèòè
åôåêòèâí³ñòü ë³êóâàííÿ, ðîçâèâàþ÷è ö³ íàâè÷êè ç ïàö³ºíòàìè ³
êîëåãàìè. Íàø³ íàóêîâî-äîñë³äíèöüê³ òà ³íôîðìàö³éíî-ïðî-
ñâ³òíèöüê³ ì³ñ³¿ ñêëàäàþòü êîíöåïö³þ, îö³íþþòü òà ñïðÿìîâó-
þòü ö³ ³äå¿ òà ïðàêòèêè íà íàö³îíàëüíîìó òà ì³æíàðîäíîìó
ð³âíÿõ (https://www.narrativemedicine.org/)
200 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ìàí³ñòè÷íèõ äîñë³äæåíü ç ¿õ ñêëàäíîþ ÿê³ñíîþ
ìåòîäîëî㳺þ, â òîé ÷àñ, ÿê â ìåäè÷í³é íàóö³, ÿê ³
ðàí³øå, äîì³íóþòü ê³ëüê³ñí³ ìåòîäè äîñë³äæåííÿ
òà ï³äõîäè. Òàêîæ â ö³ ðîêè çì³íèâñÿ ³ ñòàòèñòè÷-
íèé àíàë³ç: ÿñêðàâèì ïðèêëàäîì º àíàë³ç Rasch
(ñòàòèñòè÷íèé ï³äõ³ä äëÿ ïîë³ïøåííÿ íàøèõ ³íñòðó-
ìåíò³â îö³íþâàííÿ ðåçóëüòàò³â íà îñíîâ³ îïèòó-
âàëüíèê³â) ³ éîãî âàæëèâ³ñòü ó ÔÐÌ. Öå, ìàáóòü,
ëèøå ïðèêëàä, ³ â ÔÐÌ º íåîáõ³äí³ñòü ðóõàòèñÿ
äàë³ çà ìåæ³ êëàñè÷íî¿ ñòàòèñòèêè, ùîá çðîçóì³-
òè, ÿê êðàùå êåðóâàòè íàøèìè äàíèìè. ÔÐÌ çà
âèçíà÷åííÿì º ìóëüòè-ïðîôåñ³éíîþ, îñê³ëüêè
çàëó÷ຠâñ³õ ³íøèõ ÷ëåí³â êîìàíäè, ÿê³ íå º ë³êà-
ðÿìè. ßê ³ ó ÔÐÌ, ôàõ³âö³ ç ðåàá³ë³òàö³¿ òàêîæ âè-
ÿâëÿþòü, ùî ³ñíóþòü ìåòîäîëîã³÷í³ ïðîáëåìè ïðè
ñòâîðåíí³ îïòèìàëüíèõ ³ àäåêâàòíèõ äîñë³äæåíü ïî
¿õ êîíêðåòíèì îáëàñòÿì ³íòåðåñ³â. Âñå ùå â³äñóò-
í³ìè º ãàðíà òåðì³íîëîã³ÿ, êîíêðåòí³ âèçíà÷åííÿ
á³ëüøîñò³ ïðàêòèê, ùî çàñòîñîâóþòüñÿ äëÿ ðåàá-
³ë³òàö³éíèõ òà âèì³ðþâàëüíèõ ³íñòðóìåíò³â. Íàì íå
âèñòà÷ຠêîìïëàºíòíîñò³. Ùå íå º óòî÷íåíèìè
ãàðí³ âèçíà÷åííÿ äëÿ îïèñó ðåàá³ë³òàö³éíèõ ïðàê-
òèê (íàâ³òü ÿêùî äåÿê³ ñïðîáè âæå áóëè çðîáëåí³10
– ³ íåùîäàâíî ïðèéíÿò³ òàêîæ æóðíàëàìè ÔÐÌ11,
³ öå â³äíîñèòüñÿ äî ðîçä³ëó ìàòåð³àëè ³ ìåòîäè:
ðåçóëüòàòè äîñë³äæåíü, íàé÷àñò³øå, íå ìîæóòü
áóòè â³äòâîðåí³ ³íøèìè êîìàíäàìè, îñê³ëüêè çà-
íàäòî áàãàòî íåâ³äîìèõ. Âñå ùå ïîâèííà áóòè
÷³òêî âèçíà÷åíîþ ïîäàëüøà ôóíäàìåíòàëüíà ðî-
áîòà, ÿê ³ ðåçóëüòàòè äîñë³äæåíü òà ¿õ çàñòî-
ñîâí³ñòü. Öå ëèøå äåÿê³ ïðèêëàäè ðåàëüíèõ ïðîá-
ëåì ñöåíàð³þ ðîçâèòêó äîñë³äæåíü ç ÔÐÌ, àëå
ÿñíî, íàñê³ëüêè çàä³ÿíà âñÿ äîñë³äíèöüêà ñôåðà ç
ÔÐÌ, âêëþ÷àþ÷è êð³ì äîñë³äíèê³â, òàêîæ ðåäàê-
òîð³â ³ ñòîðîíí³õ ïëàòíèê³â. Íà çàê³í÷åííÿ, äîñë³-
äæåííÿ â ÔÐÌ íàéáëèæ÷èìè ðîêàìè ç³òêíåòüñÿ ç
íèçêîþ âèêëèê³â, ïîâ’ÿçàíèõ ç³ ñöåíàð³ÿìè ðîçâèò-
êó äîñë³äæåíü âçàãàë³ ³ ÔÐÌ, çîêðåìà. ßêùî
ï³ä³éòè äî íèõ íàëåæíèì ÷èíîì, çà äîïîìîãîþ
àäåêâàòíèõ äîñë³äæåíü, ïðîâåäåíèõ àäåêâàòíèìè
ìåòîäàìè ³ ïðåäñòàâëåíèõ íàóêîâîþ ë³òåðàòóðîþ
àäåêâàòíî¿ ÿêîñò³, âñ³ ö³ ïðîáëåìè ñòàíóòü ïðèâî-
äîì äëÿ çðîñòàííÿ ðåïóòàö³¿ ³ âàæëèâîñò³ íàøî¿
ñïåö³àëüíîñò³ ÔÐÌ.
Ãàðìîí³çàö³ÿ ðîçâèòêó ÔÐÌ ïî âñ³é ªâðîï³
Ãàðìîí³çàö³ÿ ÔÐÌ ïî âñ³é ªâðîï³ – öå ïîñò³éíèé
ïðîöåñ, ÿêèì çàéìàþòüñÿ Ñåêö³ÿ ³ Ðàäà ÔÐÌ
ªÑÌÑ ó ñï³âïðàö³ ç ªâðîïåéñüêèì òîâàðèñòâîì
ÔÐÌ ³ ªâðîïåéñüêîþ àêàäå쳺þ ðåàá³ë³òàö³éíî¿
ìåäèöèíè. ßê íàñë³äîê, òå, ùî áóäå çðîáëåíî â
íàéáëèæ÷îìó ìàéáóòíüîìó, áóäå ïðÿìèì ïðîäîâ-
æåííÿì òîãî, ùî áóëî çðîáëåíî äîòåïåð, ³ áóäå
ïðåäñòàâëåíî íèæ÷å. Òðèâàë³ñòü æèòòÿ çðîñòàº
¹2(2) *2018

ÿê â ðîçâèíåíèõ êðà¿íàõ, òàê ³ â êðà¿íàõ, ùî ðîç-
âèâàþòüñÿ. Ùî º á³ëüø âàæëèâèì, ïîêðàùåííÿ
âèæèâàííÿ ï³ñëÿ òðàâìè òà õâîðîá, à òàêîæ ñòà-
ð³ííÿ íàñåëåííÿ ïðèçâåäå äî çá³ëüøåííÿ ïîòðå-
áè â ðåàá³ë³òàö³éíèõ ïîñëóãàõ ó âñ³õ ºâðîïåéñüêèõ
êðà¿íàõ, äå î÷³êóºòüñÿ òàêîæ âèñîêà ÿê³ñòü
æèòòÿ 12 .
ßê ðåçóëüòàò, ñèñòåìè ðåàá³ë³òàö³¿ ïîâèíí³ ïî-
ñò³éíî ðîçâèâàòèñÿ ç óðàõóâàííÿì íàñòóïíèõ ïðèí-
öèï³â:
– ðåàá³ë³òàö³ÿ ï³ñëÿ òðàâìè àáî õâîðîáè òà ïðè
õðîí³÷íèõ çàõâîðþâàííÿõ º îñíîâíèì ïðàâîì
ëþäèíè13;
– ñïðàâåäëèâèé ³ ëåãêèé äîñòóï äî âñ³õ àñïåêò³â
ðåàá³ë³òàö³¿, âêëþ÷àþ÷è ñïåö³àë³çîâàíó ðåàá³-
ë³òàö³éíó ìåäèöèíó, äîïîì³æí³ òåõíîëî㳿 òà
ñîö³àëüíó ï³äòðèìêó äëÿ ö³ëîãî íàñåëåííÿ â
ªâðîï³;
– ð³âíîì³ðíî âèñîê³ ñòàíäàðòè äîïîìîãè â ðåàá³-
ë³òàö³¿, âêëþ÷àþ÷è ãàðàíò³þ ÿêîñò³ òà âòðó÷àí-
íÿ, ´ðóíòîâàí³ íà íàóêîâèõ äîêàçàõ;
– íàóêîâà îñíîâà ðîçðîáêè ìîäåëåé ðåàá³ë³òàö³¿
òà ñòàíäàðò³â äîïîìîãè äëÿ êåð³âíèöòâà êë³í³-
÷íîþ ïðàêòèêîþ.
Çîêðåìà, Êîì³òåò ïðîôåñ³éí³é ïðàêòèö³ (ÊÏÏ)
Ñåêö³¿ ÔÐÌ ªÑÌÑ áàãàòî ðîê³â äîêëàäíî ïðàöþ-
âàâ, ùîá îïèñàòè ïðîôåñ³éí³ êîìïåòåíòíîñò³
ë³êàð³â ÔÐÌ. Ïðî öå ñâ³ä÷àòü ïóáë³êàö³¿ ñòàòåé ó
ì³æíàðîäíèõ æóðíàëàõ. Á³ëà êíèãà ç ÔÐÌ â ªâðîï³,
ÿêà áóëà îïóáë³êîâàíà â 2006 ðîö³ â äâîõ âæå çãà-
äóâàíèõ æóðíàëàõ ç ÔÐÌ ³ ïîòî÷íèé âèïóñê òðå-
òüîãî âèäàííÿ Á³ëî¿ êíèãè, º îäíèì ³ç ïðèêëàä³â
âêëàäó ÊÏÏ òà âèñîêîãî ð³âíÿ ñï³âïðàö³ ç ³íøèìè
ªâðîïåéñüêèìè îðãàíàìè ÔÐÌ. Ñåð³ÿ îïóáë³êîâà-
íèõ äîñë³äíèöüêèõ ðîá³ò ùîäî ðîë³ òà êîìïåòåíò-
íîñòåé ë³êàð³â ÔÐÌ áóëà ç³áðàíà â åëåêòðîíí³é
êíèç³ ï³ä íàçâîþ «Ñôåðà êîìïåòåíòíîñòåé ë³êàð³â
ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ òåðàﳿ – ÷àñòèíà ïåð-
øà»14. Öÿ åëåêòðîííà êíèãà ì³ñòèòü íàñòóïí³ îïóá-
ë³êîâàí³ ñòàòò³:
– ïëàí ä³é Êîì³òåòó ïðîôåñ³éíî¿ ïðàêòèö³ Ñåêö³¿
Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè ªÑÌÑ:
îïèñ ³ ðîçâèòîê íàøî¿ ñôåðè êîìïåòåíòíîñòåé15;
– îïèñ òà ðîçâèòîê ñôåðè êîìïåòåíòíîñòåé â
Ô³çè÷í³é òà Ðåàá³ë³òàö³éí³é Ìåäèöèíè â ªâðîï³
– ïðîëîã äî ñå𳿠ñòàòåé, îïóáë³êîâàíèõ Êîì³-
òåòîì ïðîôåñ³éíî¿ ïðàêòèêè Ñåêö³¿ ÔÐÌ ªâðî-
ïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â
(ªÑÌÑ) 16;
– ì³æäèñöèïë³íàðíà êîìàíäà, ùî ïðàöþº ó
ô³çè÷í³é òà ðåàá³ë³òàö³éí³é ìåäèöèí³5;
– ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà â ãîñòðèõ
çàêëàäàõ 17;
– ïðîãðàìè ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿ ìåäèöèíè
â ï³äãîñòðèõ çàêëàäàõ18;
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 11 – ÂÈÊËÈÊÈ ÒÀ ÏÅÐÑÏÅÊÒÈÂÈ ÌÀÉÁÓÒÍÜÎÃÎ ÔÐÌ
– ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà òà îñîáè ç
äîâãîòðèâàëèìè îáìåæåííÿìè æèòòºä³ÿëü-
íîñò³19;
– íîâ³ òåõíîëî㳿, ïðèçíà÷åí³ äëÿ ïîë³ïøåííÿ
ôóíêö³îíóâàííÿ: ðîëü ë³êàðÿ ô³çè÷íî¿ òà ðåàá³-
ë³òàö³éíî¿ ìåäèöèíè20;
– ðîëü ñïåö³àë³ñòà ô³çè÷íî¿ òà ðåàá³ë³òàö³éíî¿
ìåäèöèíè ùîäî ä³òåé òà ï³äë³òê³â ç íàáóòîþ
÷åðåïíî-ìîçêîâîþ òðàâìîþ21;
– ºâðîïåéñüê³ ìîäåë³ ìóëüòèäèñöèïë³íàðíî¿ ðåà-
á³ë³òàö³éíî¿ äîïîìîãè ïðè ÷åðåïíî-ìîçêîâ³é
òðàâì³ 22;
– ðîëü ñïåö³àë³ñòà Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿
Ìåäèöèíè ïðè ë³ìôàòè÷íîìó íàáðÿêó23;
– ãåíåðàë³çîâàíèé òà ðåã³îíàëüíèé áîëüîâèé ñèí-
äðîì ì’ÿêèõ òêàíèí. Ðîëü ë³êàð³â Ô³çè÷íî¿ òà
Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. ªâðîïåéñüê³ ïåðñ-
ïåêòèâè, ´ðóíòîâàí³ íà íàéêðàùèõ äîêàçàõ24;
– çàïàëüíèé àðòðèò. Ðîëü ë³êàð³â Ô³çè÷íî¿ òà Ðå-
àá³ë³òàö³éíî¿ Ìåäèöèíè. ªâðîïåéñüê³ ïåðñïåê-
òèâè, ´ðóíòîâàí³ íà íàéêðàùèõ äîêàçàõ25;
– îñòåîïîðîç. Ðîëü ë³êàð³â Ô³çè÷íî¿ òà Ðåàá³ë³òà-
ö³éíî¿ Ìåäèöèíè. ªâðîïåéñüê³ ïåðñïåêòèâè,
´ðóíòîâàí³ íà íàéêðàùèõ äîêàçàõ26;
– îñòåîàðòðèò. Ðîëü ë³êàð³â Ô³çè÷íî¿ òà Ðåàá³ë³-
òàö³éíî¿ Ìåäèöèíè. ªâðîïåéñüê³ ïåðñïåêòèâè,
´ðóíòîâàí³ íà íàéêðàùèõ äîêàçàõ27;
– ìåíåäæìåíò áîëþ â ñïèí³. Ðîëü ë³êàð³â Ô³çè÷-
íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. ªâðîïåéñüê³
ïåðñïåêòèâè, ´ðóíòîâàí³ íà íàéêðàùèõ äîêà-
çàõ 28 ;
– ì’ÿçîâî-ñêåëåòí³ ïîðóøåííÿ ëîêàëüíèõ ì’ÿêèõ
òêàíèí ³ ïîøêîäæåííÿ. Ðîëü ë³êàð³â Ô³çè÷íî¿ òà
Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. ªâðîïåéñüê³ ïåðñ-
ïåêòèâè, ´ðóíòîâàí³ íà íàéêðàùèõ äîêàçàõ29;
– ë³êóâàííÿ áîëþ â ïëå÷àõ. Ðîëü ë³êàð³â Ô³çè÷íî¿
òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. ªâðîïåéñüê³ ïåð-
ñïåêòèâè, ´ðóíòîâàí³ íà íàéêðàùèõ äîêàçàõ30;
– ì’ÿçîâî-ñêåëåòí³ ïåð³îïåðàö³éí³ ïðîáëåìè. Ðîëü
ë³êàð³â Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè.
ªâðîïåéñüê³ ïåðñïåêòèâè, ´ðóíòîâàí³ íà íàéêðà-
ùèõ äîêàçàõ31.
 ÊÏÏ òðèâàþòü äîñë³äæåííÿ êîìïåòåíòíîñ-
òåé íàøèõ ë³êàð³â ïðè ³íøèõ ñòàíàõ çäîðîâ’ÿ òà
ðåçóëüòàòè áóäóòü âïåðøå îïóáë³êîâàí³ â çàçíà÷å-
íèõ æóðíàëàõ. Òàêîæ ³íòåíñèâíà ðîáîòà ïðîäîâ-
æóºòüñÿ â ³íøèõ êîì³òåòàõ ó ò³ñí³é ñï³âïðàö³ ç
ªâðîïåéñüêèì òîâàðèñòâîì òà ªâðîïåéñüêîþ àêà-
äå쳺þ. Ìåòîþ º íàäàííÿ êîðèñíèõ åëåêòðîííèõ
êíèã íàøèì êîëåãàì äëÿ ¿õ ïîâñÿêäåííî¿ ïðàêòè-
êè, à òàêîæ äëÿ çàõèñòó òà ïðîïàãóâàííÿ ñïåö³àëü-
íîñò³ ÔÐÌ ñåðåä ìåäè÷íèõ ïðàö³âíèê³â ³íøèõ
ñïåö³àëüíîñòåé òà íà ïåðåãîâîðàõ ç îðãàíàìè
äåðæàâíî¿ ñèñòåìè îõîðîíè çäîðîâ’ÿ. Äóæå âàæ-
ëèâà ³ çíà÷íà ðîáîòà âèêîíóºòüñÿ â Êîì³òåò³
201
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
êë³í³÷íèõ ñòîñóíê³â (ÊÊÑ) ñåêö³¿ ÔÐÌ ªÑÌÑ
ùîäî àêðåäèòàö³¿ ÿêîñò³ ïðîãðàì äîïîìîãè â
ªâðîï³. Öÿ ðîáîòà òðèâຠç âíåñêîì óñ³õ ÷ëåí³â
ÊÊÑ. ßê ïðèêëàä ðîáîòè, ùî ïîñòຠïåðåä íàìè
äëÿ äîñÿãíåííÿ âñ³õ öèõ ö³ëåé, ìè ïðåäñòàâëÿºìî
òóò àìá³òíèé Ïëàí ä³é Ñåêö³¿ òà Ðàäè ÔÐÌ ªÑÌÑ
íà ïåð³îä 2014-2018 ðð.:
À. Çàãàëüíå:
1. Ïîäàëüøèé ðîçâèòîê â³äíîñèí ç ªÑÌÑ.
2. Ðîçâèòîê â³äíîñèí ç óñ³ìà ³íøèìè Ñåêö³ÿìè ³
Ðàäàìè ªÑÌÑ, îñîáëèâî ç ðåëåâàíòíèìè äî
ÔÐÌ ñåêö³ÿìè.
3. Ò³ñíà ñï³âïðàöÿ ç ªÒÔÐÌ òà ªÀÐÌ: ïåðåãëÿä
Á³ëî¿ êíèãè ç ÔÐÌ ó ªâðîï³ 2006 ð., óçãîäæåí³
ïëàíè ä³é (ç óíèêíåííÿì íàäëèøêîâèõ ä³é).
4. Çáàëàíñîâàíå ñï³âðîá³òíèöòâî ç ISPRM òà
³íøèìè ì³æíàðîäíèìè Îðãàíàìè ÔÐÌ.
5. Ðîçâèòîê çâ’ÿçê³â ³ç ñëóæáàìè ÂÎÎÇ, ÿê³ çàé-
ìàþòüñÿ Îáìåæåííÿì Æèòòºä³ÿëüíîñò³ òà
Ðåàá³ë³òàö³ºþ.
6. Ñïðèÿòè ïëàíó ä³é ÂÎÎÇ ùîäî îáìåæåííÿ
æèòòºä³ÿëüíîñò³ òà çä³éñíèòè äåÿê³ çàõîäè äëÿ
éîãî ïðàêòè÷íîãî çä³éñíåííÿ.
7. Çì³íèòè íàçâó ñïåö³àëüíîñò³ ÔÐÌ ó Äîäàòêó V
Äèðåêòèâè ªÑ ïðî ïðîôåñ³éíó êâàë³ô³êàö³þ íà
“Ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà” òà
ì³í³ìàëüíèé ïåð³îä íàâ÷àííÿ â³ä 3 äî 4 ðîê³â.
8. ϳäòðèìàòè ðîçâèòîê ñèñòåì ìåäè÷íî¿ ðåàá³ë-
³òàö³¿ ó êðà¿íàõ Ñõ³äíî¿ ªâðîïè (íàïð. Ðîñ³ÿ,
Óêðà¿íà òîùî).
9. Ðåîðãàí³çóâàòè âåá-ñàéò, ùîá ïðîìîòóâàòè
ä³ÿëüí³ñòü íàøî¿ Ñåêö³¿ òà Ðàäè.
10.Ïîøèðþâàòè íàø³ äîêóìåíòè íà ³íøèõ Ñåêö³ÿõ
³ Ðàäàõ ªÑÌÑ, äëÿ ¿õ ³íôîðìóâàííÿ ïðî íàøó
ä³ÿëüí³ñòü.
11.Ñïðèÿòè ³ìïëåìåíòàö³¿ ÌÊÔ (̳æíàðîäíà êëà-
ñèô³êàö³ÿ ôóíêö³îíóâàííÿ, îáìåæåííÿ æèòòº-
ä³ÿëüíîñò³ òà çäîðîâ’ÿ) ó ùîäåííó ïðàêòèêó
ÔÐÌ.
Á. Ðàäà:
1. Çá³ëüøèòè ê³ëüê³ñòü ó÷àñíèê³â äëÿ Ñåðòèô³êàö³¿
Ðàäîþ øëÿõîì ³ñïèò³â ÷åðåç:
à. Íàäàííÿ îñîáëèâèõ ñòèìóë³â íà ïåð³îä 2–
3 ðîêè.
á. ²íòåíñèâíîãî ðåêëàìóâàííÿ ÷åðåç Íàö³î-
íàëüíèõ ìåíåäæåð³â òà Íàö³îíàëüí³ òîâàðè-
ñòâà ÔÐÌ âàæëèâ³ñòü áóòè “fellow” ªÐÔÐÌ
(FEBPRM), ùî º “Ïå÷àòêîþ äîñêîíàëîñò³”
íà ºâðîïåéñüêîìó ð³âí³.
â. Ïóáë³êàö³¿ ñòàòò³, ïðèñâÿ÷åí³é ñòàòóñó
“fellow” ªÐÔÐÌ (ïåðåâàãè, âèãîäè, øëÿõè
äîñÿãíåííÿ ñòàòóñó).
ã. Ñï³âïðàö³ ç çàö³êàâëåíèìè êðà¿íàìè, ùîá çðî-
áèòè ³ñïèòè Ðàäè íàö³îíàëüíèìè òåîðåòè÷-
íèìè ³ñïèòàìè.
202 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
2. Çá³ëüøèòè ê³ëüê³ñòü àêðåäèòîâàíèõ íàâ÷àëüíèõ
öåíòð³â ó êîæí³é êðà¿í³ ªÑ.
3. ϳäâèùèòè ðåñåðòèô³êàö³þ fellow, ñòàðøèõ
fellow, òðåíåð³â ³ íàâ÷àëüíèõ öåíòð³â.
4. Åëåêòðîííà êíèãà äëÿ äîäèïëîìíîãî íàâ÷àííÿ
ç ÔÐÌ.
5. Ãàðìîí³çàö³ÿ ïðîãðàìè òà íàâ÷àííÿ ç ÔÐÌ ñå-
ðåä êðà¿í ªÑ. Ïîâòîðíî ïðîïèñàòè ¿¿ äëÿ âêëþ-
÷åííÿ äî ïåðåãëÿíóòî¿ Á³ëî¿ êíèãè ç ÔÐÌ â
ªâðîï³.
6. ϳäòðèìêà áåçïåðåðâíî¿ ìåäè÷íî¿ îñâ³òè òà
äîñë³äæåíü ó ñôåð³ ÔÐÌ (àêðåäèòàö³ÿ ªâðî-
ïåéñüêîãî êîíãðåñó òà íàâ÷àëüíèõ ïðîãðàì,
åëåêòðîííèõ êíèã òà âèáðàíèõ ðåñóðñ³â òîùî).
Â. Êîì³òåò ïðîôåñ³éíî¿ ïðàêòèêè:
1. Åëåêòðîííà êíèãà Ñôåðè êîìïåòåíòíîñòåé
ë³êàð³â ç ÔÐÌ – ×àñòèíà 2.
2. Ïóáë³êàö³ÿ äîêóìåíò³â ïðî ðîëü ÔÐÌ ó ê³ëüêîõ
ñëóæáàõ, ïîòðåáà â åëåêòðîíí³é êíèç³.
3. Ñï³âïðàöÿ ç Cochrane Rehabilitation Field.
4. Ðîçðîáêà Ñòàíäàðò³â ïðàêòèêè â ªâðîï³.
Ã. Êîì³òåò êë³í³÷íèõ ñòîñóíê³â:
1. Ïîäàëüøèé ðîçâèòîê ªâðîïåéñüêî¿ àêðåäèòàö³¿
ÿêîñò³ ïðîãðàì.
2. Ïîçèö³éíèé äîêóìåíò ïðî ïðàâà ïàö³ºíò³â.
3. Ãàðìîí³çîâàí³ íàñòàíîâè ùîäî ïîñëóã ç ÔÐÌ íà
ºâðîïåéñüêîìó ð³âí³.
4. Ñïðèÿòè ñòàíäàðòàì àìáóëàòîðíî¿ ðåàá³ë³òàö³¿.
Ä. Ïîñò³éíà ðîáî÷à ãðóïà ç áàëüíåîëî㳿:
1. Çá³ð âñ³õ äîêóìåíò³â ç äîêàçîâî¿ ìåäèöèíè äëÿ
Áàëüíåîëîã³÷íèõ ïîñëóã
2. Ïóáë³êàö³ÿ ïîçèö³éíîãî äîêóìåíòó ç áàëüíåî-
ëî㳿.
²íøèì ïðèêëàäîì òîãî, ÿê ñïðèÿòè ìàéáóòí³é
ãàðìîí³çàö³¿, º â³äêðèòòÿ â 2014 ðîö³ ä³àëîãó ³ â³äíî-
ñèí çà ñïåö³àëüí³ñòþ ÔÐÌ ç ë³êàðÿìè ç Ðîñ³¿, ÿê³
ïðàêòèêóþòü ÷àñòêîâî ðåàá³ë³òàö³éíó ìåäèöèíó
àáî ô³çè÷íó ìåäèöèíó. Âîíè áàæàëè ñï³âïðàöþâàòè
ç Ñåêö³ºþ òà Ðàäîþ ªÑÌÑ ç ïèòàíü ÔÐÌ, äëÿ
òðàíñôîðìàö³¿ ¿õíüî¿ ïðàêòèêè â³äïîâ³äíî äî ìîäåë³
Çàõ³äíî¿ ªâðîïè òà çãîäîì ñòâîðèòè ñïåö³àëüí³ñòü
Ô³çè÷íà ³ Ðåàá³ë³òàö³éíà Ìåäèöèíà â Ðîñ³¿. Ïëàí
áóâ ñòâîðåíèé ó ñï³âïðàö³ ç Ðîñ³éñüêîþ àñîö³àö³ºþ
ï³ä íàçâîþ ARUR (Ñîþç ðåàáèëèòîëîãîâ Ðîññèè).
Áóëè îðãàí³çîâàí³ ÷îòèðè ñåì³íàðè, òðèâàë³ñòþ ïî
îäíîìó òèæíþ êîæíèé, ó ÿêèõ âçÿëè ó÷àñòü 35
ðîñ³éñüêèõ êîëåã, êîíñóëüòàíò³â äåê³ëüêîõ ðåàá³-
ë³òàö³éíèõ â³ää³ëåíü Ðîñ³¿. Ïåðøèé ñåì³íàð áóâ
îðãàí³çîâàíèé ó ³ëüíþñ³ â ãðóäí³ 2014 ðîêó, äðó-
ãèé ó Ìîñêâ³ â áåðåçí³ 2015 ðîêó, òðåò³é ó Êàçàí³ â
÷åðâí³ 2015 ðîêó òà ÷åòâåðòèé ó ãðóäí³ 2015 ðîêó.
Ïðåäñòàâëåí³ ëåêö³¿ îõîïëþâàëè âñ³ ñôåðè ñïåö³-
àëüíîñò³ ÔÐÌ, ÿê âîíè îïèñàí³ â íàø³é íàâ÷àëüí³é
ïðîãðàì³. Ç âåðåñíÿ 2015 ð. ðîçïî÷àòî ï³ëîòíèé
ïðîåêò ó òðèíàäöÿòè ðåã³îíàõ Ðîñ³¿ äëÿ ïîð³âíÿí-
¹2(2) *2018

íÿ ñòàðî¿ ñèñòåìè ðåàá³ë³òàö³¿ ç íîâîþ ñèñòåìîþ.
Ïðîåêò òðèâàâ îäèí ð³ê, ³ Ñåêö³¿ áóëî çàïðîïîíî-
âàíî îö³íèòè ïåðåá³ã öüîãî ïðîåêòó. ʳëüêà ïðîôå-
ñîð³â ïîãîäèëèñÿ ïîä³ëèòèñÿ ñâî¿ìè çíàííÿìè ³ äîñ-
â³äîì. Âîíè â³äâ³äàëè óñ³ 13 ðåã³îí³â ïðîåêòó, â³ä
Ìîñêâè ³ Ñàíêò-Ïåòåðáóðãà äî Êàçàí³, äî Âëàäè-
âîñòîêó, äî Ñèá³ðó äî Óðàëó, äî Ñàìàðè òîùî.
Ó÷àñíèêè ñåì³íàð³â óñï³øíî òà ç åíòóç³àçìîì ïðî-
äîâæóâàëè ïðîåêò, òà âîíè ïî÷àëè íàâ÷àòè ³íøèõ
ìîëîäèõ ë³êàð³â ó Ðîñ³¿, ùîá ñòàòè ë³êàðÿìè ÔÐÌ
ó ñâî¿é âëàñí³é êðà¿í³ äëÿ áëàãà ñâî¿õ ïàö³ºíò³â.
Ñï³âïðàöÿ ARUR ç Ñåêö³ºþ ³ Ðàäîþ òðèâàòèìå â
äîâãîñòðîêîâ³é ïåðñïåêòèâ³, à äåëåãàòè ç ARUR
ïðîäîâæàòü áðàòè ó÷àñòü, ÿê ñïîñòåð³ãà÷³ íà çàñ-
³äàííÿõ Ñåêö³¿ òà Ðàäè ³ ªâðîïåéñüêîãî òîâàðè-
ñòâà. Ó 2016 ðîö³ äî Ñåêö³¿ ÔÐÌ ªÑÌÑ çâåðíó-
ëîñü íåùîäàâíî ñòâîðåíå Óêðà¿íñüêå òîâàðèñòâî
ÔÐÌ, ùîá äîïîìîãòè â êðà¿í³ òðàíñôîðìàö³¿ ïðàê-
òèêè ðåàá³ë³òàö³¿ òà âïðîâàäæåííÿ ñòàíäàðò³â ªÑ
ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè. Ïëàí ä³é
áóâ ó çíà÷í³é ì³ð³ òàêèé æå, ÿê îïèñàíèé âèùå äëÿ
Ðîñ³¿.
Âíåñîê äî ïîë³òè÷íîãî ïëàíóâàííÿ
Ñïåö³àëüí³ñòü ÔÐÌ ïîâèííà áóòè îñíîâíèì
ñï³âó÷àñíèêîì ñïðèÿííÿ ñòâîðåííþ ñó÷àñíî¿ ïîë³-
òèêè â ãàëóç³ îõîðîíè çäîðîâ’ÿ ÷åðåç ¿¿ ñïåöèô³÷íó
ñïðÿìîâàí³ñòü íà ôóíêö³îíóâàííÿ ³ íà âñþ ëþäè-
íó, à í³ íà îêðåì³ çàõâîðþâàííÿ. Á³íîì³àëüíå â³äíî-
øåííÿ çäîðîâ’ÿ/õâîðîáà âñå á³ëüøå çîñåðåäæóºòü-
ñÿ íà “ïàòîãåíåç³” (ï³äõ³ä, çîñåðåäæåíèé íà
÷èííèêàõ, ùî ñïðè÷èíþþòü çàõâîðþâàííÿ), à í³ íà
“ñàëþòîãåíåç³” (ï³äõ³ä, çîñåðåäæåíèé íà ôàêòîðàõ,
ùî ï³äòðèìóþòü çäîðîâ’ÿ òà áëàãîïîëó÷÷ÿ ëþäè-
íè). Îäíàê öÿ ïàðàäèãìà ïîâ³ëüíî çì³íþºòüñÿ.
Ïðîòå, ïîêè ùî íåäîñòàòíüî îá³çíàíîñò³ íàñåëåí-
íÿ òà ïîë³òèê³â ïðî ä³éñíó çíà÷èì³ñòü Ôóíêö³îíó-
âàííÿ äëÿ Çäîðîâ’ÿ (â éîãî ö³ë³ñíîìó ðîçóì³íí³) ³
â ïëàí³ ñîö³àëüíî-åêîíîì³÷íèõ íàñë³äê³â Îáìåæåí-
íÿ æèòòºä³ÿëüíîñò³. Ôàêòîì º òå, ùî ñòàòèñòè÷í³
çâ³òè ³ ïîë³òè÷íà óâàãà á³ëüøîþ ì³ðîþ ïðèêóò³ äî
ïîêàçíèê³â äèòÿ÷î¿ ñìåðòíîñò³, çàõâîðþâàíîñò³ òà
¿¿ ïîøèðåíîñò³, àáî î÷³êóâàíî¿ òðèâàëîñò³ æèòòÿ, à
íå äî ôóíêö³îíàëüíèõ ïîêàçíèê³â, òàêèõ, ÿê ÿê³ñòü
æèòòÿ ó çäîðîâ’¿, Functional Independence Measure,
Î÷³êóâàíà òðèâàë³ñòü æèòòÿ â çäîðîâîìó ñòàí³
(Healthy Life Expectancy, HALE) àáî Ðîêè æèòòÿ,
ñêîðèãîâàí³ ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³
(Disability-Adjusted Life-Years, DALYs). Öå, áåçó-
ìîâíî, åòè÷íèé ïðèíöèï ñêåðóâàòè âñ³ íàø³ çóñèë-
ëÿ, ùîá ëþäè âèæèëè; òàêîæ, öå íîðìàëüíî, ùî öå
áóëî íàéâàæëèâ³øèì ôîêóñîì ó ªâðîï³ äî ïðîãðåñó
ìåäèöèíè â îñòàíí³ ñòîë³òòÿ. Íåçâàæàþ÷è íà öå,
íå çäàºòüñÿ ëîã³÷íèì, ùî ç êðàùèìè øàíñàìè íà
¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 11 – ÂÈÊËÈÊÈ ÒÀ ÏÅÐÑÏÅÊÒÈÂÈ ÌÀÉÁÓÒÍÜÎÃÎ ÔÐÌ
âèæèâàííÿ ïàö³ºíòàì íå íàäàºòüñÿ íåîáõ³äíà
ï³äòðèìêà äëÿ äîñÿãíåííÿ ãàðíîãî æèòòÿ. Á³ëüø
òîãî, àáñîëþòíî àáñóðäíî âèì³ðþâàííÿ “çäîðîâ’ÿ”
ìàñøòàáàìè ñìåðòíîñò³ àáî îö³íþâàííÿ íàøîãî
æèòòÿ çà ñòàòèñòèêîþ ñìåðò³. Ìè âñ³ çíàºìî, ùî,
äîñÿãíóâøè ÷óäîâèõ ïîêàçíèê³â òàêîãî íèçüêîãî
ïîêàçíèêà äèòÿ÷î¿ ñìåðòíîñò³, ìè îïèíèìîñÿ ç
çíà÷íîþ ê³ëüê³ñòþ ä³òåé ç âàæêèìè îáìåæåííÿìè
æèòòºä³ÿëüíîñò³, ÿê³ òàêîæ åòè÷íî çàñëóãîâóþòü
íà íàøó ñàìîâ³ääàí³ñòü. Òå ñàìå ìîæíà ñêàçàòè ³
ïðî ëþäåé, ÿê³ âèæèâàþòü ï³ñëÿ äóæå òÿæêèõ
òðàâì, ñåðéîçíèõ çàõâîðþâàíü àáî íàâ³òü æèâóòü
çíà÷íî äîâøå â óìîâàõ õðîí³÷íèõ ñòàí³â òà ñòàí³â,
ùî ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³. Âñ³
âîíè çàñëóãîâóþòü íà íåîáõ³äíó ðåàá³ë³òàö³éíó
äîïîìîãó. Íåçâàæàþ÷è íà òå, ùî ÔÐÌ çîñåðåä-
æóº ñâîþ óâàãó íà âñ³õ öèõ àñïåêòàõ, öå ïîêè ùî
íå çðîçóì³ëî äëÿ ïîë³òèê³â òà çàãàëüíî¿ ïîïóëÿö³¿.
ÌÊÔ áóëà ðîçðîáëåíà Âñåñâ³òíüîþ îðãàí³çàö³ºþ
îõîðîíè çäîðîâ’ÿ òà ïðèéíÿòà ÔÐÌ â ÿêîñò³ äîâ³ä-
êîâî¿ ñèñòåìè. Àëå öå ùå íå òàê íà á³ëüø çàãàëü-
íîìó ð³âí³, íàâ³òü ÿêùî º ïðèêëàäè çàñòîñóâàííÿ
íå ò³ëüêè â îñâ³ò³, àëå íàâ³òü ó òàêèõ ãàëóçÿõ, ÿê
³íæåíåð³ÿ òà àðõ³òåêòóðà. Ó íàñòóïí³ ðîêè êðèòè÷-
íèì º âíåñîê ÔÐÌ ó ïåðåíåñåíí³ ôîêóñó ç ð³âíÿ
ñìåðòíîñò³ ³ çàõâîðþâàíîñò³ ò³ëüêè íà çäîðîâ’ÿ ³
ôóíêö³îíóâàííÿ. Ùå îäíèì ïèòàííÿì º ðîçïîä³ë
ðåñóðñ³â îõîðîíè çäîðîâ’ÿ ì³æ ïîñëóãàìè äëÿ ãî-
ñòðèõ òà äîâãîòðèâàëèõ ñòàí³â çäîðîâ’ÿ, âêëþ÷à-
þ÷è îáìåæåííÿ æèòòºä³ÿëüíîñò³ òà ñòàíè çäîðî-
â’ÿ, ÿê³ ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³.
Ìè ñüîãîäí³ ñïîñòåð³ãàºìî âåëèê³ çóñèëëÿ, ñïðÿ-
ìîâàí³ íà íàäàííÿ ãîñòðî¿ äîïîìîãè, ç áëàãîðîä-
íîþ ìåòîþ çáåðåæåííÿ á³ëüøî¿ ê³ëüêîñò³ æèòò³â.
² íàâïàêè, íåìຠí³ÿêèõ ïîð³âíÿííèõ ³íâåñòèö³é ó
íåâ³äêëàäíó àáî íàñòóïíó äîïîìîãó äëÿ íàéêðàùî-
ãî â³äíîâëåííÿ ³ äëÿ äîñÿãíåííÿ ìàêñèìàëüíî¿
ôóíêö³îíàëüíî¿ ïðîäóêòèâíîñò³. Ïðîòå, ö³ ³íâåñòèö³¿
äîçâîëÿòü îòðèìàòè íå ò³ëüêè ïåðåâàãè â ÿêîñò³
æèòòÿ ³ áëàãîïîëó÷÷ÿ ïàö³ºíò³â, àëå ³ ìåíø³ âèò-
ðàòè íà ìàéáóòíþ äîïîìîãó. Äî öüîãî æ â³äíî-
ñèòüñÿ ïîñï³õ ³ ïð³îðèòåòí³ñòü äîñòàâëåííÿ ïàö³º-
íòà â ãîñòð³ â³ää³ëåííÿ íåâ³äêëàäíî¿ äîïîìîãè, â
òîé ÷àñ, ÿê ðåàá³ë³òàö³ÿ ÷àñòî ³ãíîðóºòüñÿ àáî çàò-
ðèìóºòüñÿ. Äîïîìîãà ïðè ãîñòðèõ ñòàíàõ ïîâèííà
áóòè ïîð³âíÿíîþ ç ï³äòðèìêîþ ïðîöåñó â³äíîâëåí-
íÿ. Ó öüîìó ïðàãíåíí³ ÔÐÌ – öå ìåäè÷íà ñïåö³-
àëüí³ñòü, ÿêà ìîæå çàáåçïå÷èòè óðÿäè íåîáõ³äíèì
äîñâ³äîì ó ïëàíóâàíí³ ïîë³òèêè ðåàá³ë³òàö³¿ â³äïî-
â³äíî äî ïîòðåá íàñåëåííÿ. ÔÐÌ ìîæå äîïîìîã-
òè â ïëàíóâàíí³ åôåêòèâíèõ Ìåðåæ Ðåàá³ë³òàö³é-
íî¿ Äîïîìîãè; íàäàòè ñâ³é äîñâ³ä äëÿ ðîçâèòêó
â³ää³ëåíü, îáëàäíàííÿ òà ëþäñüêèõ ðåñóðñ³â; ðîç-
áóäîâ³ á³ëüø áàæàíèõ îïåðàòèâíèõ ìîäåëåé. Ùå
îäí³ºþ çðîñòàþ÷îþ ïðîáëåìîþ º òóðáîòà ïðî õðî-
203
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ
í³÷íèõ õâîðèõ, ÿê³ ïîñò³éíî ïåðåì³ùóþòüñÿ ç
îäíîãî â³ää³ëåííÿ â ³íøå, áåç êîíêðåòíî¿ îðãàí³çà-
ö³éíî¿ ìîäåë³. Ó òîé ÷àñ, ÿê ë³êàð³ çàãàëüíî¿ ïðàê-
òèêè ìîæóòü ïðîïîíóâàòè àäåêâàòíó êîìïå-
òåíòí³ñòü ïðè âèíèêíåíí³ íîâèõ çàõâîðþâàíü,
ïàö³ºíòè ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³, àáî ç³
ñòàíàìè çäîðîâ’ÿ, ÿê³ ñïðè÷èíþþòü îáìåæåííÿ
æèòòºä³ÿëüíîñò³, àáî ç õðîí³÷íèìè ñòàíàìè, ³ç çà-
ãîñòðåííÿìè àáî òàêèìè, ùî ïîòðåáóþòü áåçïå-
ðåðâíîãî äîãëÿäó ³ ï³äòðèìêè, ïîòðåáóþòü ãàðìî-
í³çàö³¿ ¿õ äîïîìîãè, ñòâîðåííÿ êîíòèíóóìó
äîïîìîãè ì³æ ³ñíóþ÷èìè «áóíêåðàìè» íàö³îíàëü-
íèõ ñèñòåì îõîðîíè çäîðîâ’ÿ â ªâðîï³. Õðîí³÷í³ ïà-
ö³ºíòè òà îñîáè ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³
ïåðåñóâàþòüñÿ â³ä ãîñòðî¿ äî ï³äãîñòðî¿, äîâãîò-
ðèâàëî¿, àìáóëàòîðíî¿ äîïîìîãè ³ äîìàøíüî¿ äîïî-
ìîãè â ð³çí³ ìîìåíòè ñâ îñîáèñòî¿ êë³í³÷íî¿
³ñòî𳿠– öå ïîòðåáóº êîîðäèíàö³¿. Íàö³îíàëüí³
ñëóæáè îõîðîíè çäîðîâ’ÿ ïîâèíí³ ìàòè ñïåö³àë³çî-
âàí³ ï³äðîçä³ëè, ÿê³ ñòîñóþòüñÿ ðåàá³ë³òàö³éíî¿
äîïîìîãè, òà ÔÐÌ ïîâèííà ï³äâèùóâàòè çíàííÿ
ïðî öþ ïîòðåáó. Çàêîíîäàâñòâó ñë³ä âðàõîâóâàòè
ïðàâî íàñåëåííÿ íà ðåàá³ë³òàö³éíó äîïîìîãó. Öå
îçíà÷àº, ùî âñ³ ñòðàõîâ³ ïîñëóãè â ñôåð³ îõîðîíè
çäîðîâ’ÿ (äåðæàâí³ àáî ïðèâàòí³) ïîâèíí³ âðàõîâó-
âàòè ìîæëèâó ïîòðåáó ó ðåàá³ë³òàö³éíèõ ³íòåðâåí-
ö³ÿõ ï³ñëÿ òðàâìè, ãîñòðî¿ õâîðîáè àáî ïðè õðîí³÷-
íîìó ñòàí³, ùî ìîæå âèíèêíóòè ïðîòÿãîì íàøîãî
æèòòÿ. Ïðè ôîðìóâàíí³ ïîë³òèêè íåîáõ³äíî ïî-
ñò³éíî ðîçâèâàòè ñèñòåìè ðåàá³ë³òàö³¿ ç óðàõóâàí-
íÿì íàñòóïíèõ ïðèíöèï³â:
– Ðåàá³ë³òàö³ÿ ï³ñëÿ òðàâìè àáî õâîðîáè òà ïðè
õðîí³÷íèõ çàõâîðþâàííÿõ º îñíîâíèì ïðàâîì
ëþäèíè13;
– Ñïðàâåäëèâèé ³ ëåãêèé äîñòóï äî âñ³õ àñïåêò³â
ðåàá³ë³òàö³¿, âêëþ÷àþ÷è ñïåö³àë³çîâàíó ðåàá³ë³-
òàö³éíó ìåäèöèíó, äîïîì³æí³ òåõíîëî㳿 òà ñîö³-
àëüíó ï³äòðèìêó äëÿ ö³ëîãî íàñåëåííÿ â ªâðîï³;
– гâíîì³ðíî âèñîê³ ñòàíäàðòè äîïîìîãè â ðåàá³-
ë³òàö³¿, âêëþ÷àþ÷è ãàðàíò³þ ÿêîñò³ òà âòðó÷àí-
íÿ, ´ðóíòóþ÷èñü íà íàóêîâèõ äîêàçàõ;
– Íàóêîâà îñíîâà ðîçðîáêè ìîäåëåé ðåàá³ë³òàö³¿
òà ñòàíäàðò³â äîïîìîãè äëÿ êåð³âíèöòâà êë³-
í³÷íîþ ïðàêòèêîþ. Ç ó÷àñòþ ÔÐÌ ìàþòü áóòè
âïðîâàäæåí³ íàñòàíîâè, ñêåðóâàííÿ òà ðåêîìåí-
äàö³¿.
Äëÿ äîñÿãíåííÿ öèõ ö³ëåé íåîáõ³äí³ íàñòóïí³
çàõîäè:
– ïîêðàùèòè çàãàëüíå ðîçóì³ííÿ òà óñâ³äîìëåí-
íÿ ïîòðåá ëþäåé ç îáìåæåííÿì æèòòºä³ÿëü-
íîñò³;
– îïðèëþäíèòè âèãîäè ðåàá³ë³òàö³¿. Öå ïðèçâåäå
äî êóëüòóðè, â ÿê³é äîñòóï äî àäåêâàòíî¿ ðåà-
á³ë³òàö³¿ ðîçãëÿäàºòüñÿ ÿê îñíîâíå ïðàâî ëþ-
äèíè;
204 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
– ïîãëèáëþâàòè ðîçóì³ííÿ ³ ñï³âïðàöþ ì³æ íåóðÿ-
äîâèìè îðãàí³çàö³ÿìè ëþäåé ³ ñïåö³àëüí³ñòþ
ÔÐÌ;
– ñòâîðèòè êîìïëåêñí³ ðåàá³ë³òàö³éí³ óñòàíîâè â
ªâðîï³ ç³ ñïåö³àë³çîâàíèìè ³ äîáðå ï³äãîòîâëå-
íèìè ðåàá³ë³òàö³éíèìè ìóëüòè-ïðîôåñ³éíèìè
êîìàíäàìè ï³ä êåð³âíèöòâîì ë³êàð³â ÔÐÌ ³ äîá-
ðå îñíàùåíèìè â³ää³ëåííÿìè ðåàá³ë³òàö³¿. Äî-
äàòêîâî, ïîâèíí³ áóòè ñòâîðåí³ ðåàá³ë³òàö³éí³
ñòðóêòóðè äëÿ ðåàá³ë³òàö³¿, ùî íàäàºòüñÿ â ãðî-
ìàä³, äëÿ ìåíåäæìåíòó õðîí³÷íèõ çàõâîðþâàíü,
ùî ïðèçâîäÿòü äî îáìåæåíü æèòòºä³ÿëüíîñò³;
– çàñíóâàòè ñèñòåìè äëÿ çàáåçïå÷åííÿ òîãî, ùîá
ô³çè÷íà òà ðåàá³ë³òàö³éíà ìåäèöèíà ìàëà äîñ-
òàòíþ ê³ëüê³ñòü äîáðå íàâ÷åíèõ òà êîìïåòåí-
òíèõ ë³êàð³â ÔÐÌ ó âñ³õ ºâðîïåéñüêèõ êðà¿íàõ;
– âñòàíîâèòè çàãàëüí³ âèñîê³ ñòàíäàðòè äîïîìî-
ãè, ùî ´ðóíòóþòüñÿ íà ñó÷àñíèõ äîêàçàõ. Âîíè
ïîâèíí³ âðàõîâóâàòè êîíòðîëü ÿêîñò³ òà äîñòóï
äî äîïîì³æíèõ òåõíîëîã³é;
– âêëþ÷èòè íîâ³ òåõí³÷í³ ðîçðîáêè â ïðàêòèêó
ÔÐÌ. Öå äóæå âàæëèâî äëÿ ï³äòðèìêè ðåàá³ë³-
òàö³¿ â çàáåçïå÷åíí³ êðàùèõ ðåçóëüòàò³â. Âñå
÷àñò³øå òåõíîëî㳿 ïîâèíí³ çíà÷íî ñïðèÿòè â
ªâðîï³ íåçàëåæíîìó æèòòþ òà ÿêîñò³ æèòòÿ
ëþäåé ç îáìåæåííÿìè æèòòºä³ÿëüíîñò³;
– ñïðèÿòè íàóêîâ³é ä³ÿëüíîñò³ òà äîñë³äæåííÿì ó
ñôåð³ ðåàá³ë³òàö³¿ ç àäåêâàòíèì ô³íàíñóâàííÿì
äëÿ ïîêðàùåííÿ ðåçóëüòàò³â äëÿ îñ³á ç îáìå-
æåííÿìè æèòòºä³ÿëüíîñò³;
– ï³äòðèìóâàòè ñåðåäîâèùå, äå ëþäè ç îáìåæåí-
íÿìè æèòòºä³ÿëüíîñò³ ìîæóòü áóòè ïîâí³ñòþ
çàëó÷åíèìè äî ñóñï³ëüñòâà. ˳êàð ÔÐÌ áóäå
ïðàöþâàòè ç ëþäüìè ç îáìåæåííÿìè æèòòºä³-
ÿëüíîñò³ äëÿ äîñÿãíåííÿ ö³º¿ ìåòè.
Âñ³ ö³ çàõîäè êðàùå äîçâîëÿòü ëþäÿì ç îáìå-
æåííÿìè æèòòºä³ÿëüíîñò³ âíîñèòè ñâ³é ñóòòºâèé
âíåñîê ó ñóñï³ëüñòâî.
Ïîñèëàííÿ
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¹2(2) *2018 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
ÐÎÇÄ²Ë 11 – ÂÈÊËÈÊÈ ÒÀ ÏÅÐÑÏÅÊÒÈÂÈ ÌÀÉÁÓÒÍÜÎÃÎ ÔÐÌ
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205
Á²ËÀ ÊÍÈÃÀ Ç Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ (ÔÐM)  ªÂÐÎϲ

Äëÿ öüîãî äîêóìåíòó ³ì’ÿ êîëåêòèâíîãî àâòîðà Àëüÿíñ ªâðîïåéñüêèõ îðãàí³â ÔÐÌ âêëþ÷àº:
• ªâðîïåéñüêó Àêàäåì³þ Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÀÐÌ),
• ªâðîïåéñüêå Òîâàðèñòâî Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (ªÒÔÐÌ),
• Ñåêö³þ ÔÐÌ ªâðîïåéñüêîãî Ñîþçó Ìåäè÷íèõ Ñïåö³àë³ñò³â (Ñåêö³ÿ ªÑÌÑ-ÔÐÌ),
• ªâðîïåéñüêèé Êîëåäæ ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè (â îñîá³ Ðàäè ªÑÌÑ-ÔÐÌ).
• Ðåäàêòîðè 3ãî âèäàííÿ Á³ëî¿ Êíèãè ç Ô³çè÷íî¿ òà Ðåàá³ë³òàö³éíî¿ Ìåäèöèíè â ªâðîï³: Stefano Negrini,
Pero Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner,
Carlotte Kiekens, Sasa Moslavac, Enrique Varela-Donoso, Anthony B Ward, Mauro Zampolini.
• The contributors: Maria Gabriella Ceravolo, Nicolas Christodoulou, Christoph Gutenbrunner, Stefano Negrini,
Nikolaos Barotsis, Pedro Cantista, Calogero Foti, Slavica Dj. Jandric, Crt Marincek, Xanthi Michail, Daniel
Wever, Jerome Bickenbach, Kristian Borg, Leonard Li, Marta Imamura, Simon F Tang.
• Ðåäàêòîðè ïåðåêëàäó óêðà¿íñüêîþ ìîâîþ: Âîëîäèìèð Ãîëèê, Îëåêñàíäð Âëàäèìèðîâ

206 ÓÊÐÀ¯ÍÑÜÊÈÉ ÆÓÐÍÀË Ô²ÇÈ×Íί ÒÀ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍί ÌÅÄÈÖÈÍÈ / UKRAINIAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE ¹2(2) *2018